CN102711645A - Systems, apparatuses, and methods for treating tissue and controlling stenosis - Google Patents

Abstract

Systems, delivery devices, and methods to treat to ablate, damage, or otherwise affect tissue. The treatment systems are capable of delivering a coolable ablation assembly that ablates targeted tissue without damaging non-targeted tissue. The coolable ablation assembly damages nerve tissue to temporarily or permanently decrease nervous system input. The system, delivery devices, and methods can damage tissue and manage scarring and stenosis.

Description

Be used to handle tissue and control narrow system, apparatus and method

Quoting of related application

The rights and interests that No. the 61/260th, 349, the U.S. Provisional Patent Application that the application requires to submit on November 11st, 2009 according to 35 U.S.C. § 119 (e).Incorporate this piece provisional application into this paper in full by reference.

Background

Technical field

The present invention relates generally to the system, the apparatus and method that are used to handle tissue, more specifically, the present invention relates to be used to cause required reaction and control narrow system, apparatus and method simultaneously.

Description of related art

Pneumonopathy possibly cause many problems that lung functions is caused adverse effect.Pneumonopathy such as asthma and chronic obstructive pulmonary disease (" COPD ") may cause the gas-flow resistance of pulmonary to increase.The mortality rate that causes by pneumonopathy, all be considerable with healthy relevant cost and population size with adverse effect.These diseases often cause adverse effect to quality of life.Symptom is diversified, but generally includes cough, dyspnea and asthma.For example, in COPD,, may observe dyspnea when carrying out to a certain degree aggravating activities when (as running, jog, hurry up etc.).Along with advancing of disease, carry out such as the walking non-aggravating activities the time also may observe dyspnea.As time goes on, the symptom of COPD may take place during more and more littler activity, exist up to these symptoms always, thereby seriously limit the ability that the people accomplishes normal activity.

The common characteristics of pneumonopathy are airway obstruction, it stops up with the air flue chamber, airway walls thickens, in the airway walls or the change of structure on every side or above combination relevant.Airway obstruction can significantly reduce the gas exchange amount of pulmonary, thereby causes dyspnea.The obstruction in air flue chamber can be caused by too much intracavity mucus or edema fluid do or both.Airway walls thickens and can be caused by airway smooth muscle excess shrinkage, airway smooth muscle hypertrophy, mucous gland hypertrophy, inflammation, edema or above combination.The variation of air flue surrounding structure (the for example destruction of lung tissue itself) can cause the radially forfeiture of traction of airway walls and airway constriction subsequently.

The characteristic of asthma can be shunk for airway smooth muscle, smooth muscle is loose, mucus produces too much, the inflammation and the swelling of mucous gland hypertrophy and/or air flue.These are stimulus object (for example cold air, smog, anaphylactogen or other chemical substance), the systemic hormone (chemical substance of blood of local inflammation cytokine (by being arranged in the chemical substance that airway walls or near immunocyte discharge in the part), suction unusually; Like antiinflammatory hydrocortisone and analeptic epinephrine), the complicated interactional result of local nerve system input (be completely contained in the neurocyte in the airway walls, its local reflex that can produce smooth muscle cell and mucous gland stimulates) and central nervous system's input (being transmitted to the nervous system signal of smooth muscle cell and mucous gland from brain through vagus nerve).These conditions tend to cause provisional widely change in organization and initial reversibility airflow obstruction, and these finally possibly cause permanent change in organization and permanent airflow obstruction, and this makes the asthmatic patient dyspnea.Asthma may further include through the hyperergy airway smooth muscle that can significantly increase gas-flow resistance shrinks acute attack or the attack that the air flue cause further narrows down.SOA comprises repeatedly dyspnea (for example, breathe hard or out of breath), asthma, the uncomfortable in chest and cough of outbreak.

Emphysema are types of COPD, it is characterized by around pulmonary's air flue or the change of contiguous lung tissue.Emphysema can relate to the destruction of lung tissue (for example alveolar tissue, such as alveolar sac), and this causes the minimizing of gas exchange and lung tissue radially reducing of traction that airway walls is applied on every side.The destruction of alveolar tissue stays the emphysema lung areas with excessive space, its lack alveolar wall and alveolar blood capillary and so when gas exchange inefficiency.Air " stranded " is in these bigger spaces.The air of this " stranded " may cause the excessive expansion of lung, and in the scope of breast, has limited the interior stream of rich oxygen containing air and than the normal function of health tissues.This has caused significant dyspnea, and possibly cause hypoxia level and high carbon dioxide level in the blood.Even in healthy individuals, such lung tissue destruction is also taken place as the part of usual aging process.Unfortunately, be exposed to chemical substance or other material (like tobacco smoke) can significantly be accelerated tissue injury or destructive speed.Airway obstruction can further increase dyspnea.Radially weakening of traction possibly cause airway walls to become " relaxing ", makes that the air flue wall part subsides or subsides fully when exhaling.This air flue during owing to exhale subsides and airway obstruction, and emphysema are individual possibly breathe out air outside the lung.

Chronic bronchitis is a type of COPD, it is characterized by that airway smooth muscle shrinks, smooth muscle is loose, mucus produces too much, mucous gland hypertrophy and airway walls inflammation.Similar with asthma, these are local inflammation cytokine, the complicated results of interaction that sucks stimulus object, systemic hormone, local nerve system and central nervous system unusually.With respiratory obstruction is that reversible asthma is different to a great extent, and the airway obstruction of chronic bronchitis mainly is chronic and nonvolatil.Owing to breathe hard, asthma, the uncomfortable in chest and chronic sympton that produces mucous cough, for chronic bronchitis patient, breathing is difficult usually.

Different techniques can be used for assessing the order of severity and the progress of pneumonopathy.For example, pulmonary function test (pft), motor capacity and quality of life questionnaire by individual through being commonly used to estimate.Pulmonary function test (pft) relates to the objective and repeatable measurement of basic physiological lung parameter, like total air flow, lung volume and gas exchange.The index that is used to assess the pulmonary function test (pft) of obstructive pulmonary disease comprises ratio, total lung capacity, TLC (TLC), airway resistance and the arterial blood gas test of 1 second forced expiratory volume (FEV1), forced vital capacity (FVC), FEV1 and FVC.FEV1 is a patient pulmonary when being full of air fully, the volume of air that forced expiration was breathed out in first second.FEV1 also is the average discharge that takes place in FE first second.This parameter can be used for assessment and determines whether to exist any airway obstruction and influence thereof.FVC is a patient pulmonary when being full of air fully, the total volume of air that forced expiration can be breathed out.The ratio of all gas that the gas comprises that can breathe out in first second when FEV1/FVC is forced expiration can be breathed out.After giving at least a bronchodilator, FEV1/FVC ratio is less than the existence of 0.7 definition COPD.TLC is the total amount of gas in the lung when pulmonary is full of fully, and TLC may increase when in obstructive pulmonary patient's lung, bottling up air.Airway resistance is defined as barometric gradient and the ratio of the air velocity between alveolar and the mouth between alveolar and the mouth.The resistance of equally, given air flue is defined as through the barometric gradient of this given air flue and the ratio of the air-flow of this air flue of process.The amount of the oxygen in the ABG thermometrically blood and the amount of carbon dioxide, and be that assessment pulmonary and respiratory system are brought oxygen into blood and carbon dioxide taken out of the most direct method of external ability from blood from air.

The motor capacity test is that the patient carries out the objective of active ability and repeatably detection.Six minutes walk test (6MWT) be a kind of motor capacity test, wherein patient's walking as much as possible on smooth surface in 6 minutes.Another kind of motor capacity test relates to the largest motion ability of measuring patient.For example, the amount of doctor's power that can measuring patient on cycle ergometer, can produce.The patient can breathe 30% oxygen and live load can increase 5-10 watt in per 3 minutes.

Quality of life the questionnaire assess holistic health and happiness.It is a kind of quality of life questionnaire that the St.George's breathes questionnaire, and it comprises 75 problems, and it is designed for measures the influence of obstructive pulmonary disease to total health status, daily life and perception happiness.The therapeutic effect of pneumonopathy can use pulmonary function test (pft), motor capacity test and/or questionnaire to assess.Can be based on the results modification therapeutic scheme of these tests and/or questionnaire.

Anaplastic treatment relates to through melting in the lung airway walls of numerous bronchial trees and destroys smooth muscle tension force such as bronchus heat, eliminates smooth muscle and nerve in pulmonary's airway walls thus.The air flue of treatment can not be well in response to the stimulus object, systemic hormone and the part that suck and central nervous system's input.Unfortunately, the smooth muscle tension force of airway walls possibly can have a negative impact to pulmonary function with neural this destruction thus.For instance, the suction stimulus object such as smog or other toxicant can stimulate irritant receptor of lung usually and produce cough and air flue smooth muscle contraction.Eliminate nerve in the airway walls and removed partial function of nervous system and import, thereby eliminated lung is discharged toxicant through strong cough ability with nervus centralis.Eliminate airway smooth muscle tension force and possibly eliminate the ability that air flue tightens, thereby allow deeper to infiltrate through in the lung such as the harmful substance of toxicant.

Asthma and COPD are serious diseases, and its patient is more and more.Present treatment technology comprises prescription drugs, and both not exclusively success can not have no side effect.In addition, many patients do not observe its drug prescription dosage.Therefore, the treatment that can improve gas-flow resistance and not need patient's compliance need be provided.

Brief description

At least some embodiments relate to device in the tube chamber, and said device can be removed hollow organ's innervation, can prevent, minimize or limit simultaneously narrow possibility.Can treat the target area of organ, and can not cause the undesirable narrow of appreciable impact organ dysfunction.In certain embodiments, device melts the independent purpose zone that is spaced apart from each other in the tube chamber.Even take place narrowly, also can avoid extending the continuous narrow ring of 360 degree.If said organ is an air flue, can forms damage, and can not cause gas-flow resistance that any increase that perceives takes place.

In some embodiments, be used to treat individual system and comprise that size is set at the elongate member that can move along the air flue chamber.Said assembly can weaken the signal that is transmitted by nervous tissue (the for example nervous tissue of nerve trunk), can the inner surface of air flue irreversibly not destroyed to any significant degree simultaneously.In certain embodiments, one or more electrode output RF energies are handled rear portion 90 degree of air flue circumference to 180 degree, thereby remove the innervation of lung.When destroying destination organization, cooling system (for example, cooling duct) can control electrode and/or the temperature of airway tissue.

In some versions, tissue injury can be enough to cause cicatrization, reduces, limit or eliminate basically because narrowing down of perceiving of scar tissue, the air flue chamber generation that causes such as narrow but can place electrode.The spacing distance of damage can be enough to prevent that the tissue between the contiguous damage from thickening.Disclosed at least some embodiments of this paper can melt basically airway walls whole circumference and not can with the plane of air flue axis in form successive ablation tissue ring.

In some embodiments, method comprises the nervous tissue that destroys first main bronchus, is passed to the almost whole far-end bronchial trees that are connected with said first main bronchus to prevent the nervous system signal basically.Most of in the bronchial tree of the said first main bronchus far-end or all can't receive the nervous system signal.In certain embodiments, nervous tissue is between the lung that trachea and bronchus branch extends through.Said method also comprises the nervous tissue that destroys second main bronchus, is passed to the almost whole far-end bronchial trees that are connected with said second main bronchus to prevent the nervous system signal basically.In certain embodiments, along the rear portion air flue less than 180 ° or in the required part delivery of energy of air flue circumference.This has limited the amount of the tissue that is exposed to emitted energy.

In some embodiments, innervation is removed and is related to the damage that generation can influence outside adventitial tissue layer, and wherein nerve trunk is arranged in said outside adventitial tissue layer on anatomical structure.In the innervation of lung is removed, melt the nerve trunk that runs through right side and left side main bronchus outside and can cut off the airway smooth muscle that is lining in the lung airway and the product mucus body of gland and vagal contact that are positioned at air flue effectively.When this thing happens, airway smooth muscle was lax, and mucus produces and reduces.These variations can reduce the airway obstruction under the morbid state (such as COPD and asthma).The airway obstruction that reduces makes breathing easier, and this can improve individual quality of life and health status.

The air flue arm is in be lower than second temperature of said first temperature can heat damage nervous tissue through the temperature of nervous tissue being brought up to first temperature (for example, melting temperature).In some embodiments, a part that is positioned at the radially inner airway walls of nervous tissue can be in first temperature, to prevent that this part airway walls is caused permanent damage.Said first temperature can be enough high, and can cause permanent damage to nervous tissue.In some embodiments, nervous tissue is a part that is arranged in the nerve trunk of the outside connective tissue of airway walls.It is functional that smooth muscle in the airway walls and nervous tissue can keep, so that smooth muscle tension force maintains aspiration level.Air flue can shrink/expand in response to stimulating (stimulation that for example, is caused by the stimulus object, local nerve system or the systemic hormone that suck).In other embodiments, nervous tissue is nervous ramification or the part of nerve fiber in the airway walls.In other embodiments, simultaneously or destroy the nervous tissue of nerve trunk and the nervous tissue of nervous ramification/fiber in succession.But various types of starting elements (for example ablation) can be used for exporting energy.

Some embodiments are utilized the advantage of big airways anatomical structure.Vagal air flue nerve trunk is usually located at the latter half of main bronchus air flue.Main airway (being trachea, right side and left side main bronchus) Background Region does not have cartilage.The cartilaginous ring of these air flues is not a whole circumference, and only has soft tissue along their rear portion.In addition, can realize damaging away from the nervous tissue of air flue nerve trunk through producing damage less than 360 degree of (for example, significantly less than) air flue circumference to being positioned at the air flue latter half.For example, 180 degree of processing air flue circumference, 150 degree or 130 degree maybe be just enough for the innervation of effective removal air flue.Because damage has remarkable arc length less than 360 degree, therefore can significantly reduce or prevent airway constriction.

Electrode can have complicated shape (comprising arc, polygon) or have any other shape or structure.Electrode can be V-arrangement, U-shaped, L shaped, T shape, W shape, straight, crooked or above combination.In some embodiments, electrode assemblie is zigzag configuration, curl shape structure, winding escalator or coil shape structure, corkscrew shape (corkscrew) structure, helical configuration, Z-shaped structure, above combination etc.Corkscrew shape electrode assemblie can have the electrode that can independently control, and said electrode forms the discontinuous or successive damage that is substantially corkscrew shape.

Another embodiment comprises and can or all produce the successive electrode assemblie that is substantially corkscrew weakened and emaciated body wound along the part of air flue circumference.For same circumferential area, it is less that the cicatrix with small surface area produces the probability can form narrow tissue net.At least some embodiments can be handled narrow target area, to form corresponding narrow damage.The blade electrode assemblie can carry out such processing, thereby further reduces scar tissue.

Another embodiment depends on nerve, tremulous pulse and the vein that tends to companion's row in the human anatomy structure.Carrying out before the air flue innervation removes, can use the energy of ultrasonic or other type to confirm arteriae bronchiales or the venous position of walking near air flue nerve trunk place very.After confirming the position of blood vessel, with near the air flue zone of energy process blood vessel to melt the air flue nerve trunk.This technology minimizes or limits the volume of handled tissue, thereby reduces or eliminate narrow risk.

In some versions, conduit forms the damage of at least one place in the degree of depth of expectation.For example, can in a bronchus airway walls, form the damage of a place or many places corkscrew shape or spiral type, and can in another airway walls, form arc damage, thereby remove the innervation of bronchial tree different piece.Damage can or be positioned at the depths of airway walls along the inner surface of air flue, perhaps can be along the outer surface of air flue.

In some embodiments, the energy delivery apparatus comprises catheter shaft and the ablation member that is connected with said catheter shaft.Said ablation member comprises can be from collapsed mode energy emitter between cooling element that deployed condition moves and cartilage, and energy emitter comprises a plurality of electrodes that the longitudinal axis around said ablation member departs from a circumferential direction each other between said cartilage.Said electrode is configured to can be to a plurality of target areas of air flue delivery of energy, and said a plurality of target areas separate each other with respect to the longitudinal axis of said air flue.Said energy emitter and said cooling element are configured to cooperatively interact and damage to form between cartilage, and the surface texture of damage and said air flue separates and between the cartilaginous ring of said air flue between said cartilage.

In certain embodiments, delivery apparatus comprises ablation member in the tube chamber, and said ablation member comprises deployable device and a plurality of ablation and/or electrode.Said electrode is separated along the circumference of said deployable member, and can export energy to dispersive target area, thereby forms damage in said target area.At least a portion of first damage separates with second damage in the axial direction, and contiguous or overlapping with said second damage in a circumferential direction.

In certain embodiments, the individual method of treatment comprises with respect to air flue places ablation member, and exports energy from said ablation member to axially spaced air flue target area.When the long axis direction of said air flue is observed, the profile of said target area is overlapping.

In other embodiments, the individual method of treatment comprises the energy emitter that moves delivery apparatus along air flue.At least one electrode of said energy emitter is placed between the cartilaginous ring of said air flue., damage to being positioned at from said electrode to form between cartilaginous ring along the target area delivery of energy of the position that the major axis of said air flue axially separates.

The certain methods of handling tissue comprises ablation member is placed on the air flue intracavity, and utilizes at least one electrode of being placed near the said ablation member said air flue inner surface delivery of energy of organizing to said air flue.The energy of being sent destroys the target area that axially separates along said air flue, and the target area part of feasible qualification maximum cross section, said target area width is separated with the inner surface of said air flue.

In some embodiments, delivery apparatus comprises catheter shaft and the ablation member that is connected with said catheter shaft.Said ablation member comprises the deployable elements that can move to deployed condition from collapsed mode.When said deployable member was in deployed condition, energy emitter can be sent energy and produce damage, and said damage has the end that is axially offset to one another along the axial length of body structure.

Delivery apparatus can produce the continuous or discrete damage in a place or many places.Said damage can have different shapes, comprises arc, spirally (spiral shape), spiral type (helical shape), waveform, curl shape or above combination.In order to produce successive damage, ablation member can have the very near electrode of being separated by, to form successive substantially damage.Perhaps, said ablation member can have long electrode or energy emitter, and they have corresponding spirally, spiral type, curl shape etc.In other embodiments, electrode can separate enough distances, to form discontinuous damage.Can preference pattern, the size of interval and damage comes the processing target zone.

In certain embodiments, can form damage simultaneously along the diverse location of airway walls.In some versions, can form oblique damage at the offside of air flue.Whole damage can be between cartilaginous ring damages said ring avoiding.In other embodiments, damage can be passed trachea or cartilaginous ring.

Description of drawings

In the accompanying drawings, same reference number is represented similar element or assembly.

Fig. 1 has shown near lung, the lung and blood vessel and nerve in the lung.

Fig. 2 has shown according to an embodiment and has been placed on the intracavity processing system in the left principal bronchus.

Fig. 3 has shown the delivery apparatus that the access to plant from be placed on left principal bronchus stretches out.

Fig. 4 A is the air flue of bronchial tree and the sectional view of the ablation member of subsiding.

Fig. 4 B is the air flue of bronchial tree and the sectional view of unfolded ablation member.

Fig. 5 A is the sectional view that when the smooth muscle contraction of air flue and mucus are in the air flue chamber, is centered around the air flue around the ablation member of subsiding.

Fig. 5 B is the sectional view that is centered around unfolded ablation member air flue on every side.

Fig. 6 is the figure of tissue depth with respect to tissue temperature.

Fig. 7 is the side view of the ablation member in the air flue.

Fig. 8 is the isometric view with delivery apparatus of ablation member.

Fig. 9 is the sectional view of the elongate bars obtained of the line 9-9 along Fig. 8.

Figure 10 is the side view of ablation member.

Figure 11 is the longitdinal cross-section diagram of the ablation member of Figure 10.

Figure 12 is the partial cross section figure of therapy system, and wherein delivery apparatus stretches out from access to plant.

Figure 13 is the side view of ablation member.

Figure 14 is the sectional view that is centered around the air flue around the unfolded ablation member, and this sectional view is that the line 14-14 along Figure 13 obtains.

Figure 15 is the side view of ablation member.

Figure 16 is the side view that is used to produce the ablation member of oblique damage.

Figure 17 is the side view with ablation member of inner passage.

Figure 18 is the sectional view of the ablation member of Figure 17 of obtaining of 18-18 along the line.

Figure 19 is the side view with ablation member of outlet.

Figure 20 is the sectional view of the ablation member of Figure 19 of obtaining of 20-20 along the line.

Figure 21 is the side view with ablation member of V-arrangement electrod-array.

Figure 22 is the side view with ablation member of T shape electrode.

Figure 23 is the side view of multiple tooth ablation member.

Figure 24 is the side view with the right ablation member of electrode assemblie.

But Figure 25 is the side view with ablation member of cooling electrode assembly.

Figure 26 is the sectional view of the electrode assemblie that obtains of the line 26-26 along Figure 25.

Figure 27 A-31B has shown isothermal line and corresponding damage.

Figure 32 is the side view of helical form ablation member.

Figure 33 is the side view of another helical form ablation member.

Figure 34 is the isometric view with ablation member of isolated electrode.

Figure 35 is the isometric view that is placed on the ablation member of the Figure 34 in the air flue body cavity.

Figure 36 is the isometric view of the damage that forms of the ablation member by Figure 34.

Figure 37 is the isometric view of ablation member with electrode of coolant cools.

Figure 38 is the sectional view of the ablation member obtained of the line 38-38 along Figure 37.

Figure 39 A is the isometric view with ablation member of crooked energy emitter.

Figure 39 B is the isometric view by the blood vessel of the ablation member processing of Figure 39 A.

Figure 40 A is another isometric view of the ablation member of Figure 39 A.

Figure 40 B is the isometric view by the blood vessel of the ablation member processing of Figure 40 A.

Figure 41 is the isometric view of the ablation member of another embodiment.

Figure 42 is the isometric view that is in the ablation member of sending configuration.

Figure 43 is the isometric view that is in the ablation member of the Figure 42 that launches configuration.

Figure 43 A is the side view of the ablation member of Figure 43.

Figure 44 is the sectional view of distal section of the ablation member of Figure 43.

Describe in detail

Fig. 1 has showed the people's lung 10 with left lung 11 and right lung 12.Trachea 20 from nose with mouthful to extending below and being divided into left principal bronchus 21 and right principal bronchus 22.Left principal bronchus 21 is all distinguished branch with right principal bronchus 22 and is formed lobar bronchi, segmental bronchi and inferior segmental bronchus, and they have diameter that diminishes gradually and the length that shortens gradually along outside direction (being distal direction).30 of main pulmonary arteries pass through from the right ventricle of heart and in the place ahead of radix pulmonis 24.At radix pulmonis 24 places, tremulous pulse 30 branches into left and right pulmonary artery, and left and right pulmonary artery branch shape successively becomes ramose blood vessel network.These blood vessels can extend along the air flue of bronchial tree 27.Bronchial tree 27 comprises left principal bronchus 21, right principal bronchus 22, bronchioles and alveolar.Vagus nerve 41,42 extends and branch's formation nerve trunk 45 along trachea 20.

Left vagus nerve 41 passes cervical region with 42 of right vagus nerves from brain stem, and passes through chest downwards in the both sides of trachea 20.Vagus nerve 41,42 expands into nerve trunk 45, and nerve trunk 45 comprises the plexus pulmonalis of the front and rear that holds trachea 20, left principal bronchus 21 and right principal bronchus 22.Also the branch branch airway along bronchial tree 27 extends nerve trunk 45 in the branch branch airway outside of bronchial tree 27.Nerve trunk 45 is neural trunks, comprises that the hard sheath by connective tissue wraps in nerve fibre bundle together.

The major function of lung 10 is that airborne exchange of oxygen is gone into blood, and with the carbon dioxide exchange in the blood in air.When the oxygen containing air of richness was drawn into lung 10, gas exchange process began.The contraction of diaphram and intercostal chest muscle wall cooperatively interacts and reduces the pressure in the chest, makes rich oxygen containing air flow cross the air flue of lung 10.For example, air through port and nose, trachea 20, then through bronchial tree 27.Air finally is delivered to alveolar sac and carries out gas exchange process.

The blood of oxygen poor pumps through pulmonary artery 30 from right side of heart and also finally is delivered to the alveolar blood capillary.Be rich in the carbon dioxide refuse in the blood of this oxygen poor.Thin semipermeable membrane separates oxygen poor blood in the blood capillary and the rich oxygen containing air in the alveolar.These blood capillaries surround alveolar and in the middle of alveolar, extend.Diffuse into blood from airborne oxygen through film, and come the carbon dioxide of autoblood to diffuse in the air of alveolar through film.Then, new rich oxygen containing blood flows to heart from the branch vessel of alveolar blood capillary through the pulmonary vein system.Heart is delivered to whole body everywhere with the oxygen containing blood pump of richness.When diaphram and Intercostal muscle were lax, the air that has consumed oxygen in the lung was breathed out, and lung and thoracic wall return elastically normal relaxed condition.By this way, air can flow through branch's bronchioles, bronchus 21,22 and trachea 20, and final through port and nose discharge.

Fig. 2 has shown processing system 200, thereby it can handle the air-flow in adjustment expiration or air-breathing or expiration and the breathing process.Increase gas exchange in order to reduce gas-flow resistance, processing system 200 can be used for enlarging (for example, expansion) air flue.The nervous tissue (for example nervous tissue) that can influence in some versions, (in the inside of lung or outside) nerve trunk expands air flue.Nervous system uses the signal of telecommunication and chemical signal that the communication between brain and the lung 10 is provided.The activity of autonomic nervous tissue network sensation and adjusting respiratory system and vascular system.Nervous tissue comprise use chemical signal and the signal of telecommunication from a body part to feeling to another body part transmission and the fiber of movable information.For example, nervous tissue can be with the form transmitting sports information of nervous system input, such as the signal that causes muscle contraction or other reaction.Fiber can be made up of neuron.Nervous tissue can be held by connective tissue (being epineurium).Autonomic nervous system comprises the sympathetic nervous system parasympathetic nervous system of unifying.Sympathetic nervous system mainly participate in stress during " excitement " function.Parasympathetic nervous system is mainly participated in " plant " function during energy keeps.The sympathetic nervous system parasympathetic nervous system of unifying is simultaneously movable, and usually tract is produced mutual effect.The innervation of blood vessel comes from this two systems, and the innervation of air flue mainly is parasympathetic in itself, and between the lung of right vagus nerve 42 and left vagus nerve 41 and brain, transmits.

Can be in these nerve trunk 45 one or more on carry out the part that any amount of operation influences the lung relevant with these nerve trunk.Because some nervous tissue in the network of nerve trunk 45 (for example imports other nerve; The nerve that is connected with esophagus, get into the nerve of abdominal part etc. through chest), so thereby can targeting minimize, limit or eliminate basically other non-target nerve or structure are caused undesirable destruction in specific site.Some fiber of front and rear plexus pulmonalis imports little nerve trunk, and these little nerve trunk are extended along trachea 20 and branch's bronchus and bronchiolar outer surface when outwards walking into lung 10.Along branch's bronchus, these little nerve trunk are bifurcated and fiber sent into airway walls each other constantly.

Processing system 200 can influence specific nervous tissue, such as the vagus nerve tissue relevant with the objectives site.The vagus nerve tissue is included in efferent nerve fiber parallel in the nervous ramification and afferent nerve fiber.The nervus centrifugalis tissue transmits signal from brain to the air flue effector lymphocyte, and the air flue effector lymphocyte mainly is airway smooth muscle cells and product myxocyte.The nervus centripetalis tissue transmits signal from the air flue sensory receptors in response to stimulation, and extends to brain.The nervus centrifugalis tissue makes from trachea 20 and all receives innervation to the smooth muscle cell to terminal bronchiole, and the innervation of centripetal fiber mainly is confined to trachea 20 and bigger bronchus.The efferent vagus nerve tissue has the nervous activity of constant baseline to air flue, and this makes smooth muscle contraction and mucous secretion be in baseline values.Processing system 200 can influence and spread out of and/or the nervus centripetalis tissue, thus the inflammation and the tissue fluid content (for example, edema) of control airway smooth muscle (for example, making smooth muscle receive innervation), mucous secretion, neural mediation.The airway smooth muscle contraction relevant with pneumonopathy, Polyblennia, inflammation and airway walls edema usually cause high relatively gas-flow resistance, and this causes gas exchange to reduce and pulmonary function descends.

In some scheme, melt nervous tissue to weaken along the transmission of the signal of can causing of transmitting of vagus nerve 41,42 or muscle, mediate muscle contraction, mucus generation, inflammation, edema etc.Weaken and to include but not limited to obstruction, restriction, blocking-up and/or interrupt signal transmission.For example, weaken and to comprise the signal amplitude that reduces nerve signal or weaken transmission through nerve signal.Reduce or distad stop that the nervous system input of air flue can change airway smooth muscle tension force, generations of air flue mucus, airway inflammation etc., thereby control air flows into and outflow lung 10.Reduce or stop from air flue and lung to the local effect cell or to central nervous system's sensation input can also reduce that reflection bronchial stenosis, reflection mucus produce, the release of inflammatory mediator and in body lung or the organ nervous system that possibly cause the airway walls edema of other cell import.In some embodiments, can reduce the nervous system input, thereby correspondingly reduce airway smooth muscle tension force.In some embodiments, air flue mucus produces the amount that is reduced can be enough to cause cough and/or the substantive decline of gas-flow resistance.In some embodiments, the amount that airway inflammation reduced can be enough to make gas-flow resistance and reduce the ongoing inflammatory damage of airway walls is substantive.Signal weakening can make smooth muscle loosening, prevents, limits or eliminate basically the mucus generation of producing myxocyte and reduce inflammation.Under this mode, can change healthy air flue and/or ill air flue to regulate pulmonary function.After the processing, can utilize various types of questionnaires or test to assess individual reaction to handling.If desired or hope, can carry out other operates and reduces the cough frequency, reduces dyspnea, reduces asthma etc.

The main bronchus 21,22 (i.e. 1 grade of air flue (airway generation 1)) that can handle Fig. 1 and 2 influences the distal portions of bronchial tree 27.In some embodiments, at processing left side, positions and right side main bronchus 21,22 along left side and right side radix pulmonis 24 and left lung 11 and right lung 12 outsides.Treatment site can be positioned at vagus nerve branch and trachea and main bronchus 21,22 distally of remittance place and the nearside of lung 11,12 mutually.The single processing procedure that relates to two kinds of treatment application can be used to handle the most of or whole bronchial tree 27 of bronchial tree 27.The overwhelming majority that extends into the bronchial tree in the lung 11,12 can be affected, thereby high-caliber curative effect is provided.Because the arteriae bronchiales of main bronchus 21,22 have big relatively diameter and high heat absorption capacity, handle the undesirable destruction that produces so can protect these arteriae bronchiales to exempt from.

Fig. 3 has shown the delivery apparatus of conduit system 204 forms, and wherein conduit system 204 extends through access to plant 206.Conduit system 204 can be handled the air flue of main bronchus 21,22, and the air flue in main bronchus 21,22 distally.Ablation member 208 can be placed on outside the pulmonary, in right side or left side main bronchus, lobe of the lung bronchioles or the middle bronchus.Middle bronchus is formed by the part of right side main bronchus and is middle period bronchioles and the bronchiolar origin of inferior lobe.Ablation member 208 can also be placed in the more high-grade air flue distal part that (for example,>2 grades air flue) influences bronchial tree 27.

Can guide catheter system 204 carry out various operation through zigzag air flue, for example, the innervation of the cut-off parts lobe of the lung, the whole lobe of the lung, a plurality of lobe of the lung or a lung or two lungs.In some embodiments, handle lobar bronchi to cut off the innervation of the lobe of the lung.For example, but targeting in along one or more treatment site of lobar bronchi to cut off the innervation of the whole lobe of the lung that is connected with this lobar bronchi.Can handle the left lung bronchus to influence upper left leaf and/or left inferior lobe.Can handle the lobus dexter bronchus to influence right upper lobe, right middle lobe and/or right lower lobe.Can be side by side or one after the other handle the lobe of the lung.In some embodiments, the doctor can handle a lobe of the lung.Based on the effectiveness of handling, the doctor can simultaneously or one after the other handle other lobe of the lung.By this way, can handle the different separated region of bronchial tree.

Can be through handling each segmental bronchi to single treatment site delivery of energy along each segmental bronchi.For example, can be to each segmental bronchi delivery of energy of right lung.In some versions, apply 10 energy and can handle the most of or almost whole of right lung.In some versions, utilize the different energy that is less than 36 times to apply and to handle the most of or almost whole of two lungs.According to the anatomical structure of bronchial tree, often can utilizing once or twice, energy applies the innervation that cuts off segmental bronchi.

When nervous tissue is melted, can keep such as other tissue of mucous gland, cilium, smooth muscle, body pipe (for example blood vessel) etc. or the function of anatomical structure.Nervous tissue comprises neurocyte, nerve fiber, dendron and such as neuroglial supporting tissue.Neurocyte transmission electric pulse, and nerve fiber is the aixs cylinder of the prolongation of the said pulse of guiding.Said electric pulse is converted into chemical signal, thereby sets up communication with effector lymphocyte or other neurocyte.For instance, can cut off the innervation of the part air flue of bronchial tree 27, to weaken one or more nervous system signals by nervous tissue's transmission.Cut off innervation and can comprise destruction all nervous tissues, thereby the more distal location that makes all signals can't be passed to bronchial tree through the damaged section of nerve trunk basically perhaps conducts to more near the central nervous system from bronchial tree along one section nerve trunk of air flue.In addition; The directly sensory receptors of transmitting along nerve fiber from air flue (for example; Cough and costimulatory receptor) also will be interrupted near effector lymphocyte's (for example, joint back neurocyte, smooth muscle cell, myxocyte, inflammatory cell and vascular cell) signal.If a plurality of nerve trunk are extended along air flue, then can destroy each nerve trunk.Therefore, the nerve supply along segmental bronchus tree can be cut off.When signal was cut off, the distally airway smooth muscle can relax, and this causes air flue expansion, myxocyte to reduce the mucus generation or inflammatory cell stops to produce airway walls swelling and edema.These variations reduce gas-flow resistance and then increase the gas exchange in the lung 10, thereby reduce, restriction or eliminate one or more symptoms basically, such as dyspnea, asthma, uncomfortable in chest etc.The tissue of encirclement or vicinity purpose nervous tissue may be affected, but can not receive permanent damage.In some embodiments; For example; Before processing and after handling; The blood of analog quantity can be sent to the bronchial wall tissue along the bronchus blood vessel of the air flue that is processed, and the blood of analog quantity can be sent to the alveolar sac of bronchial tree 27 distal regions along the lung blood vessel of the air flue that is processed.These blood vessels can continue to transport blood to keep competent gas exchange.In some embodiments, the destruction of airway smooth muscle does not reach significant degree.For example, the not obvious smooth muscle than segment that influences respiratory function can be changed reversiblely in the airway walls.If energy is used to destroy the outer nervous tissue of air flue, the energy of treatment effective dose can not arrive the major part of non-purpose smooth muscle tissue.

Handle left principal bronchus 21 and one of right principal bronchus 22, thereby handle a side of bronchial tree 27.Can handle other main bronchus 21,22 based on the effectiveness of first processing.For example, can handle left principal bronchus 21 and handle left lung 11.Can handle right principal bronchus 22 to handle right lung 12.In some embodiments, single processing system can be destroyed the nervous tissue of one of bronchus 21,22, and in the nervous tissue that need not under the situation of trachea 20 taking-up processing systems, can also destroy other main bronchus 21,22.Therefore, just can destroy need not to take out under the situation of processing systems along the nervous tissue of main bronchus 21,22 from trachea 20.In some embodiments, can carry out all or at least quite a few (for example, bronchus air flue of at least 50%, 70%, 80%, 90%) basically that single operation comes management of patients bronchial tree easily.In other operation, after handling one of lung 11,12, can take out processing system from the patient.If desired, can in operation subsequently, handle other lung 11,12.

Fig. 4 A is the view in transverse section of healthy air flue 100, is example with the bronchus.Inner surface 102 is defined by 110 of epithelial cell plicated layers, and epithelial cell is surrounded by substrate 112a.Smooth muscle tissue's layer 114 surrounds substrate 112a.Hypothallus 112b is between muscular tissue 114 and connective tissue 124.Mucous gland 116, cartilaginous lamina 118, blood vessel 120 and nerve fiber 122 are in the hypothallus 112b.Arteriae bronchiales branch 130 and nerve trunk 45 are positioned at wall 103 outsides of air flue 100.Shown tremulous pulse 130 is positioned at the connective tissue 124 that surrounds airway walls 103 with nerve trunk 45, and its direction can be parallel to air flue 100 usually.In Fig. 1, for example, 45 of nerve trunk are extended to alveolar from vagus nerve 41,42 and along air flue 100.Nerve fiber 122 is arranged in airway walls 103 and extends to muscular tissue 114 from nerve trunk 45.The nervous system signal transmits to muscle 114 and mucous gland 116 from nerve trunk 45 through nerve fiber 122.In addition, signal transmits to the central nervous system through nerve trunk 45 from sensory receptors (for example, cough, stimulus object and stretching).

Can destroy, stimulate or otherwise change cilium to cause required replying along epithelial cell 110, thus the transportation of control (for example, increase or reduce) mucomembranous cilium.Can suck a lot of particulate matters when the people breathes, the function of air flue performance filter is removed particulate matter from air.Mucomembranous cilium transportation system is for the mechanism of all air flue performance self-cleanings of whole lung 10.Mucomembranous cilium transportation is to remove mucous main method from the distal part of lung 10, and then as the main immunologic barrier of lung 10.For example, the inner surface 102 of Fig. 4 A can be covered and be coated with mucus by cilium.As the part of mucomembranous cilium transportation system, mucus is caught the particulate matter (for example, deleterious pollutant are such as tobacco smoke) of many suctions and is made these particulate matters to laryngeal movement.The distal position mucous blanket that the fibre swing of cilium makes lung 10 moves through larynx with the pantostrat of the particulate matter of catching, and moves to pharynx and be used for discharging from respiratory system.Ablation member 208 can be destroyed cilium to reduce the mucomembranous cilium transportation or to stimulate cilium to improve the mucomembranous cilium transportation.

Ablation member 208 can be moved into the deployed condition of Fig. 4 B, thereby optionally handles the target area (for example, the anatomical structure among substrate 112a, the 112b, nerve trunk 45 etc.) in the airway walls 103.For example, can destroy mucous gland 116, make mucus produce the mucus accumulation that the amount that reduces is enough to prevent to cause the gas-flow resistance increase, simultaneously,, keep enough mucus to produce to keep effective mucomembranous cilium transportation like needs or hope.Also can destroy nervous ramification/fiber through other anatomical structure in airway walls 103 or the airway walls 103.Damage is formed at ad-hoc location to prevent significantly to reduce the narrow or scar tissue through the air-flow of air flue 100.

Natural body function can help prevent, reduces or limit the damage to tissue.130 blood can absorb heat energy in the blood vessel, can carry the heated zones of heat energy away from branch 130 then.By this way, blood can alleviate or avoid the damage to blood vessel 130.After handling, arteriae bronchiales branch 130 can continue to keep the health of lung tissue.Melt in the embodiment at some RF, the RF energy of ablation member 208 output q.s destroys whole vertical section of nerve trunk 45 and does not destroy blood vessel 130.

Assessment to treatment effect can be at least to a certain extent based on one or more air flue characteristics, pulmonary function test (pft), motor capacity test and/or questionnaire.Can assess to follow the tracks of and to monitor their progress individuality.If desired or hope, can carry out other process up to realizing required reaction.Can use the dissimilar instrument that is used to assess the air flue characteristic.During melting, can show from the feedback of instrument whether target tissue is melted.In case target tissue is melted, the non-destination organization of health followed destruction (if any) thereby can stop to treat minimizing or limiting.

Can assess to confirm on-unit the different qualities of air flue.Said air flue characteristic includes but not limited to; The physical property of air flue (for example; Air flue compliance, shrinkage etc.), the dimension in airway resistance, air flue chamber (for example; The shape of air flue, the diameter of air flue etc.), the reactivity of air flue (for example, reactivity), muscle property (for example, muscle tone, muscular tone etc.), inflammatory cell, inflammatory cytokine etc. to stimulating.In some embodiments, can change the variation of monitoring the air flue muscle property through the pressure that measurement is expanded in the ablation member 208 of known pressure.The effect (if any) that the doctor changes confirm handle according to pressure, said effect include but not limited to whether destination organization has been stimulated, melted etc.

Fig. 5 A and 5B are the view in transverse section of the part of air flue 100, and air flue 100 has the smooth muscle tissue 114 that is in contraction state, from the mucus 150 of the mucous gland 116 of undue growth and inflammatory swelling and the edema fluid do that airway walls 103 is thickened.Muscular tissue 114, mucus 150 of shrinking and the airway walls 103 that thickens cooperatively interact and occlusion lumen 101 partly, and this causes high relatively gas-flow resistance.Destroy nervous tissue 45 and come relaxed muscle tissue 114, expansion air flue 100, thus reduce gas-flow resistance, therefore allow more air to arrive the alveolar sac that is used for gas exchange process.Airway resistance reduces the channel opener that possibly show air flue, the channel opener that for example weakens in response to the nervous system input of these air flues.Can limit or minimize narrow, can significantly not increase with the gas-flow resistance after guaranteeing to handle.Therefore, processing should be guaranteed the permanent reduction of air flue gas-flow resistance, even after processing a very long time.

With (for example handle rudimentary air flue (low generation ariways); Main bronchus, lobar bronchi, segmental bronchi) decline of relevant airway resistance can be greater than the slippage of the airway resistance relevant with processing high level air flue (high generation ariways) (for example, inferior segmental bronchus).The air flue that the doctor can select to be suitable for handling is realized reducing of desired airway resistance, and can be in the patient oral cavity, and the bronchial tree of treatment site nearside, trachea or any other suitable position are measured.Can be before treating, in the treatment and/or treatment back measures airway resistance.In some embodiments, for example through using the position measurement airway resistance of exhaust-gas treatment system in bronchial tree, said exhaust-gas treatment system allows to breathe than the zone in distally from treatment site.

Ablation member 208 can utilize energy to melt nerve 45, thereby for good and all expands air flue 100.Term as used herein " energy " is with its extensive interpretation; (for example include but not limited to heat energy, cold energy; Cooling energy), electric energy, acoustic energy are (for example; Ultrasonic energy), RF energy, pulse high-voltage energy, mechanical energy, ionizing radiation, optical energy (for example, luminous energy) and above combination, and the energy that is suitable for handling other type of tissue.In some embodiments, conduit system 204 delivery of energy and one or more materials (for example, radioactive particle, radioactive substance etc.), therapeutic agent etc.Nonrestrictive example therapeutic agent includes but not limited to one or more antibiotic, anti-inflammatory agent, pharmaceutically active substance, bronchoconstriction agent, bronchodilator (for example, receptor, agonist, anticholinergic agents etc.), nerve block medicine, photoreaction agent or above combination.For example, can long-acting or fugitive nerve block medicine (for example, anticholinergic agents) be delivered to nervous tissue, thus the transmission of temporary transient or permanent attenuated signal.Can also material directly be delivered to neuropeptide 11 22 or nerve trunk 45 or both, thereby destroy nervous tissue with chemical mode.

Fig. 6 and 7 is presented in the ablation member 208 by the top layer heating of RF energy and cools off the effect that is produced with the deep layer heating and by the top layer of circulating coolant.Coolant absorbs heat energy, makes the tissue that contacts with the cooling section 209 of ablation member 208 be cooled.Cooling section 209 can damage the tissue between ablation member 208 and neural or other purpose tissue to limit or to prevent from the heat energy of airway walls 100 absorption capacities.

Transverse axis among Fig. 6 is corresponding to the degree of depth (unit be millimeter) from getting into airway walls tissue with the point of the contact point of electrode assemblie 214 or adjacent electrode assembly 214, and the longitudinal axis is corresponding to tissue temperature (unit be degree centigrade).Except as otherwise noted, the temperature among the figure is degree centigrade.Figure puts corresponding to contact point or contact area between electrode assemblie 214 and the airway walls tissue last " 0 ".Three curve A, B and C among the figure are corresponding to the RF energy of being sent into three kinds of different capacity levels of tissue.Temperature among the figure is high to about 100 ° of C.Shown about 100 ° of C or lower slightly temperature because this temperature is considered to RF melt during the upper limit of tissue temperature.When about 90 ° of C, tissue fluid comes to life, coagulation of tissues and carbonization, thus increase its impedance greatly and damage its ability to airway walls organized delivery RF energy.Therefore, tissue temperature maintains that to be lower than about 90 ° of C be desirable.When about 50 ° of C, the following temperature of line 216 expressions: be higher than this temperature histiocyte death then takes place; Being lower than this temperature then organizes and will can not receive secular substantial influence (or any The Long-term Effect).

Curve A shown in Figure 6 is illustrated in what happens when carrying out or not carrying out electrode assemblie 214 coolings under relatively low power (for example, the about 10 watts RF energy) level.Curve A is divided into three sections A1, A2 and A3.The extension of phantom line segments A2 representative exponential curve A3 when not applying cooling.As viewed through curve A, when not cooling off, the temperature at electrode tissue interface reaches 80 ° of C, and index descends along with the increase of the distance in the tissue that gets into air flue 100.As shown in the figure, curve A 3 intersects with the dead boundaries of 50 ° of C histiocytes being represented by line 216 at about 5 millimeters degree of depth place.Therefore, during electrodeless cooling, the degree of depth that cell death takes place is served as reasons apart from represented about 5 millimeters of d1.Under this power level, further cell death will stop.

If adopt initiatively cooling, temperature drops to obviously lower level, for example, as curve A 1 represented be about 35 ° of C at 0 millimeter place in the electrode tissue interface distance.Because this temperature is lower than 50 ° of C, thus the point that intersects at the cell death line of curve A 2 and 50 ° of C apart from d2 (for example 3 millimeters the degree of depth) apart from the surface before cell death can not take place.From 3 millimeters to as cell death will take place apart from 5 mm depths of d3 representative.This cooling ablation procedure is favourable, because it allows cell death and disorganization to locate to take place in distance electrode-organizational interface's one segment distance (or distance range), and can not destroy the tissue under epithelial cell and the epithelial cell.In some embodiments, can melt the nervous tissue of walking and do not destroy epithelial cell or understructure, such as substrate and smooth muscle cell along the air flue outside.

Curve B is illustrated in what happens when carrying out or not carrying out the electrode cooling under the higher power level (like 20 watts RF energy).The extension of the exponential curve of the non-refrigerated situation lower curtate B3 of section B 2 representatives of curve B.Can find out; Electrode tissue temperature at the interface is near 100 ° of C; This is worthless, because at this temperature undertissue-electrode interface place tissue fluid boiling and tissue coagulation and carbonization will take place, and then can significantly increase tissue impedance and damage the ability of in airway walls, sending extra RF energy.Through initiatively cooling is provided, the temperature at curve B 1 show electrode-organizational interface place drops to about 40 ° of C, and at 2 millimeters the degree of depth to curve B 3 and 50 ° of about 8 millimeters degree of depth generation cell deaths that intersect on the dead border of C histiocyte like the d4 representative.Therefore, can find out that it is possible using higher power level the cell death in darker and bigger zone to be provided and not to reach undesirable high temperature (temperature that for example, causes coagulation of tissues and carbonization in electrode tissue at the interface).Said system can be used in and realizes the subsurface cell death of airway epithelia, thus do not need deface, thus help the patient from treatment, to recover as early as possible.

Curve C is represented higher power level, for example, and 40 watts RF energy.Curve C comprises section C1, C2 and C3.Dotted line section C2 is the extension of exponential curve C3.Section C2 shows that electrode tissue temperature at the interface far surpasses 100 ° of C, and under less than the refrigerative situation of active, is inappropriate.Using under the refrigerative situation of active; The temperature at electrode tissue interface is near 80 ° of C; And progressively raise and near 95 ° of C, exponentially property decline subsequently intersects at by about 15 mm distance of representing apart from d6 in electrode tissue interface apart from the airway epithelia surface with 50 ° of C cell death lines 216.Because initial temperature is higher than 50 ° of C cell death lines 216, it is dead from epithelial surface to about 15 millimeters degree of depth histiocyte will to take place, thereby disorganization big and dark zone is provided.

Fig. 7 has showed the cross section TEMPERATURE SPECTROSCOPY of one section airway walls, thereby the RF energy is sent ablation tissue through this section airway walls.Term " melts (ablate) " or the material alterations of electrical properties, engineering properties, chemical property or other character that " melting (ablation) " (derivative words that comprises them) includes but not limited to organize.Melt and to relate to breaking-up or permanent damage, damage or tissue damage.For example, melt that disorganization, lysis, the cell size that can comprise localization reduce, downright bad or above combination.Under the pulmonary ablation application background, term " melts " and comprises the character that changes nervous tissue fully, thereby blocks the nervous tissue of signal of telecommunication transmission through melting basically.

Isothermal curve is represented when power being applied to electrode assemblie 214 and with coolant (for example; The saline of room temperature or brine ice) when being delivered in the capsule 212, the temperature that the temperature that electrode assemblie 214 reaches and distance electrode-organizational interface 215 get into the different depth place of airway walls 100.Term " element (element) " under the background of " deployable elements (expandable element) " or " deployable elements (deployable element) " comprises independent component or a plurality of independent component.For instance, deployable elements can be a plurality of capsules of single capsule or fluid communication with each other.

Feed the speed of capsule 212 and the temperature of coolant and the size of capsule 212 through power delivery rate, the coolant of regulating counter electrode assembly 214 and can change isothermal line.Through selecting the power delivery rate of suitable coolant temperature and flow velocity and counter electrode assembly 214, realize that the temperature of A=60 ° of C of isothermal line, B=55 ° C, C=50 ° C, D=45 ° C, E=40 ° C and F=37 ° of C is possible.Further regulate and make that the temperature that realizes A=50 ° of C of isothermal line, B=47.5 ° C, C=45 ° C, D=42.5 ° C, E=40 ° C and F=37 ° of C also is possible.Have only 50 ° of C isothermal lines can be heated to and be enough to inducing cell death with interior those zones that comprise.In some versions, the tissue at about 2mm to 8mm degree of depth place can be melted in the airway walls, and other the non-destination organization less than 2mm degree of depth place will remain below the temperature that can cause cell death in the airway walls.

With reference to Fig. 8, conduit system 204 comprises control module 210, and control module 210 links to each other with the conduit with elongate bars 230 207.Deployed condition shown in capsule 212 can expand into from collapsed mode.When capsule 212 expands, can electrode assemblie 214 be moved to airway walls.Expansible capsule 212 can help electrode assemblie 214 is maintained near (for example, be close to said tissue or contact with said tissue) of tissue that delivery of energy passes through.Coolant can absorb heat energy and come cooling bladder 212 or electrode assemblie 214 or both.

Control module 210 generally includes controller 244 and fluid delivery system 246.Controller 244 includes but not limited to one or more processors, microprocessor, digital signal processor (DSP), field programmable gate array (FPGA) and/or special IC (ASIC), storage device, bus (bus) and power supply etc.For example, controller 244 can comprise the processor with one or more storage device intercommunications.Bus can be connected to processor with inside or external power source.Memorizer can adopt various ways, comprises, for example, one or more buffers, buffer (register), random-access memory (ram) and/or read only memory (ROM).Controller 244 also can comprise the display screen 245 and input equipment 250 such as screen.Input equipment 250 can comprise keyboard, touch pad etc., and can be operated by user and control conduit 207.

Controller 244 can be stored different programs.User can select to be used for the program of the characteristic of record organization and required target area.For example, the lung that is filled with air has high relatively impedance, and lymph node can have medium impedance, and blood vessel can have low relatively impedance.Controller 244 can be confirmed suitable program based on impedance.Can optimize performance based on the feedback of the pick off of detected temperatures, tissue impedance etc.For example, controller 244 can be controlled the operation of ablation member 208 based on tissue temperature.If the tissue surface temperature overheating can strengthen cooling and/or reduce electrode power, protect surface texture simultaneously thereby produce the deep layer damage.

Internal electric source 248 (dotted line is represented among Fig. 8) can be a power generator, such as radio frequency (RF) electromotor.Can be with required frequency output RF energy.The instance of frequency includes but not limited to the frequency range of about 50KHZ to about 1000MHZ.When the RF energy was directed in the tissue, energy was converted to heat in tissue, made the temperature of tissue reach about 40 ° of C to about 99 ° of C.Can apply the RF energy and continue about 1 second to about 120 seconds.In some embodiments, RF generator 248 has single passage and about 1 watt to the 25 watts RF energy of transmissibility, and has the ability of continuous-flow.Also can use frequency, interval and the power output of other scope.In addition, internal electric source 248 can be an energy accumulating device, such as one or more batteries.Can be with energy delivery to electrode assemblie 214, it converts electric energy to RF energy or another kind of suitable form of energy.Other form of energy that can be sent comprises microwave, ultrasonic, unidirectional current or electromagnetic energy.In addition, can utilize cryogenic ablation.Can send through bar 230 and be used for cooling off the low temperature heat exchanger on the ablation member 208 being in cryogenic fluid.

Fluid delivery system 246 comprises fluid source 260 that is connected in supply pipe 268 and the fluid container 262 that is connected in return pipe 272.Fluid source 260 can comprise the container that is contained in the outer cover unit 264 (for example, bottle, jar, groove or be used to hold the container of fluidic other type).In the embodiment that can pressurize, fluid source 260 comprise one or more can be to the pressue device (for example, one or more pumps, compressor etc.) of coolant pressurization.Temperature control equipment (for example, Po Er pastes (Peltier) device, heat exchanger etc.) can cool off or regenerative fluid.Fluid can be a coolant, comprises saline, deionized water, cold-producing medium, cryogenic liquid, gas etc.In other embodiments, fluid source 260 can be can preserve cold coolant and it is delivered to the heat-insulated container of supply pipe 268.Coolant distad flows through elongate bars 230 along delivery lumen 326, and fills ablation member 208.Flow through elongate bars 230 through return cavity 324 proximads from the coolant in the ablation member 208, and finally flow into container 262.

Pick off 247 (shown in the dotted line) is connected with controller 244 communications.Controller 244 can be based on controlling conduit 207 from the signal of pick off 247 (for example, pressure transducer, temperature sensor, thermocouple, pressure transducer, touch sensor etc.).Pick off can also place on the electrode assemblie 214, places or places on any other position along elongate bars 230.In the close loop maneuver pattern; Can energy delivery be arrived electrode assemblie 214 based on the feedback signal from pick off 247, said pick off can be configured to transmit the signal that (or transmission) shows one or more tissue signatures, Energy distribution, tissue temperature or any other measurable purpose parameter.Based on these readings, controller 244 is regulated the operation of electrode assemblie 214.In the open loop operator scheme, the operation of electrode assemblie 214 can be set by user input.For example, user can tissues observed temperature or impedance readings and manual adjustments power level.In addition, power supply can be configured to fixed power mode.In other embodiments, conduit system 204 can be switched between close loop maneuver pattern and open loop operator scheme.

With reference to Fig. 8 and 9, elongate bars 230 comprises power line chamber 320a-h, delivery lumen 326 and return cavity 324.Power line 280a-280h (being referred to as " 280 ") extends through power line chamber 320a-320h (being referred to as " 320 ") respectively and controller 244 and electrode assemblie 214 is coupled together.Can being processed by one or more following materials in whole or in part of elongate bars 230: metal, alloy are (for example; Steel alloy; Such as rustless steel), plastics, polymer and above combination and other biocompatible materials; And can be flexible, thereby can easily pass through hyperbranched air flue.

With reference to Figure 10 and 11, power line 280 from power supply 248 to electrode assemblie 214 delivery of energy.In some embodiments, power line 280 passes the outer wall of chamber 234 and capsule 212.In other embodiments, the adapter of electrode assemblie 214 is arranged in chamber 234.Power line 280 can extend between adapter and elongate bars 230, thereby avoids being exposed to body fluid.

Electrode assemblie 214 can include but not limited to monopolar electrode, bipolar electrode, metal electrode, line electrode, needle electrode etc., and can form the array of circumferential damage, and the damage of every place is only extended along the part of the circumference of blood vessel or body structure.If body structure is an air flue, the damage of then every place can be surrounded the chamber of air flue at least in part.Damage can have less than the arc length of 360 degree (for example, about 25 degree are to about 45 degree).In some embodiments, damage separates with respect to the longitudinal axis of body structure.Damage jointly covers required circumference.For example, damage can be overlapping with the section start of next place damage on circumference (for example, when when the axial length of body structure is observed), and separate each other in the vertical, thereby guarantee to handle the whole circumference (or part of circumference) of air flue.

Electrode assemblie 214 comprises the electrode 229 that separates along on capsule 212 circumferencial directions.Each electrode 229 has a pair of exposed electrodes element.The electrode member 231d of electrode 229d and the element 231e of adjacent electrode 229e can cooperatively interact and form the RF arc that can melt adjacent tissue radially.Electrode 229 can be connected with the outer surface of capsule 212.In other embodiments, electrode 229 can embed the sidewall of capsule 212 or otherwise be fixed to capsule 212.

Can operate adjacent electrode 229 with bipolar fashion, one of them electrode is anodal, and another electrode is a negative pole, makes it possible to the RF power delivery through tissue.If electrode 229 is a monopolar electrode, this electrode can be connected to independent power line 280 so, thereby allows to control independently each electrode.Perhaps, electrode 229 can be connected to same power line so that co-operate.

Capsule 212 in whole or in part can be by polymer, plastics, silicon, rubber, polyethylene, polrvinyl chloride, chemical inert material, non-toxic materials, electrically insulating material or above materials such as combination are processed.Heat passage for strengthening, the capsule sidewall can comprise one or more Heat Conduction Materials with high heat conductance.For example, heat conduction bar (for example, bonding jumper) can help heat energy is come out from focus (if any) conduction.Capsule 212 (for example can conform to airway surface; Cartilaginous ring; Side is propped up etc.) on irregularly shaped, and can process by following material in whole or in part: expandable material, such as polyurethane (for example; Low hardness polyurethane) or the highly conforming properties material of other type, said material can be transparent, translucent or opaque.Capsule 212 can have different expanded shape, comprises hot dog shape, oval, cylindrical etc.For handler's bronchial tree, the diameter D of swelling bag 212 can for about 12mm to about 18mm.For the motility of enhancement process, the diameter of expansible capsule can for about 5mm to about 25mm.The size of capsule 212 can be set to other organ or tissue that can handle other animal.Shown in figure 11, expand in order to make capsule 212, fluid is sent and through inlet 225 along delivery lumen 326.Coolant flows along return cavity 324 proximads at chamber 234 internal recycle then.

Figure 12 and 13 has showed an illustrative methods utilizing processing system 200.With before implementing treatment, during the treatment and/or after treating, can observe air flue 100 and locate and evaluation process site and non-destination organization.Access to plant 206 can be guiding tube, delivery sheath, tracheascope or endoscope, and can comprise one or more finders, such as optical viewing arrangement (for example, photographing unit), optical system (for example a, set of shots) etc.Can stimulate (for example, electricity irritation) zones of different, to confirm the position of air flue nerve trunk or morbid state along the air flue circumference.The airway smooth muscle in distally that can be through measuring the point of implementing to stimulate along airway length shrinks the detection that realizes bronchoconstriction.Can change through the pressure of monitoring expansible capsule or the pick off of air flue nearside or other type of contacting with air flue is measured muscle contraction.Said technology can minimize or limit the circumferential area of the air flue that is processed, thereby reduces or eliminate the risk of airway constriction.Can confirm nerve location through following manner: measure the electroneurographic signal of the point on the air flue circumference, with the position of confirming that air flue is neural.Can use air flue nerve signal stimulus object to increase the nerve signal amplitude, thereby be convenient to the air flue nerve signal location around the air flue circumference such as cold air, histamine or phenyl two guanidines.

When body cavity moves the access to plant 206 of Figure 12, the ablation member 208 of subsiding is maintained in the service aisle 386.Ablation member 208 is distad shifted out working chamber 386 and makes its expansion, thereby electrode assemblie 214 is moved to (for example, contacting near airway walls or with airway walls) near the airway walls.The RF energy can come heat tissue (for example, textura epidermoidea and deep tissues) through tissue, thereby forms damage in the target area.Target area and relevant damage are substantially corresponding to the dotted line of Figure 13 and 14.

The term " damage " that this paper uses is meant that by the tissue of permanent destruction promptly, phalangeal cell is dead.In some cases, energy is sent the cell beyond the zone that is called " damage " is caused destruction temporary transient or non-lethality.For example, energy as herein described is sent and can temporarily be destroyed or change epithelial cell or smooth muscle cell.Yet advantageously, through using the difference cooling, these cells can recover and keep function, therefore are not considered to the part of said " damage ".By contrast, ablation member 208 can be to being positioned at the airway walls depths or causing permanent damage at airway walls outside nervous tissue or other destination organization, thereby weaken the nerve signal that causes some pneumonopathy.

The cooling section 209 contact airway walls 100 of Figure 13, thus can cools tissue when electrode assemblie 214 output energy.It is this that to carry out the heating of top layer and deep layer and carry out the refrigerative clean effect in top layer through circulating coolant through the RF energy be with the skin of heat accumulation to airway walls 100.The temperature of connective tissue can be higher than the temperature of epithelium, substrate and/or smooth muscle.For example, the temperature of connective tissue is can be enough high and can cause damage to nerve trunk tissue or other deep tissues, makes other non-destination organization of air flue remain on lower temperature to prevent or to limit the damage to non-destination organization simultaneously.

Figure 13 and 14 has shown the independent damage 237a-h in eight places (being referred to as " 237 ").Adjacent damage 237 axially departs from along the longitudinal axis 233 of ablation member 208 each other.Shown in figure 14, every place damage 237 can have the arc length of about 45 degree, makes the whole circumference of the basic upper edge of damage array airway walls 100 extend.The length of exposed electrodes element is corresponding to the width of damage 237.Can select the length (for example, the length of electrode member 231d, 231e) of exposed electrodes element based on the desired width of damage 237.Advantageously, can form damage 237 simultaneously.For example, can form all or most damage 237 simultaneously, to avoid between ablation process, to move ablation member.In other embodiments, thus can start different electrode 229 forms damage in succession.Can electrode assemblie 214 be moved to different positions and melt different tissues.Therefore, can side by side or one after the other carry out the one or many damage based on required processing.

Utilize conventional ablation catheter, ablation procedure can be enough to cause cicatrization, and said cicatrix possibly cause partial air flue constriction or narrow.Because the diverse location that damage 237 is in along airway length is so can alleviate narrow influence.Shown embodiment is very suitable for cutting off the innervation of air flue, avoids forming successive scar tissue ring simultaneously.The continuous scar tissue ring of spending along the inner periphery extension 360 of air flue 100 can significantly reduce the sectional area in air flue chamber, and then significantly increases gas-flow resistance.Staggered damage 237 can help to alleviate reducing of air flue chamber cross-sectional area.

Figure 14 has shown and has damaged 237 position.Shown in figure 14, damage 237 exterior contour along the major axis of air flue 100 and with the virtual plane of said axis on projection define successive basically closed hoop.Because nerve trunk 45 along air flue 100 longitudinal extensions, can be in the degree of depth that sufficient to guarantee melts all nerve trunk so damage 237.In other embodiments, electrode assemblie 214 can only be used to handle the part of air flue circumference, for example 180 of air flue circumference degree, 150 degree or 130 degree.This maybe be just enough for the innervation of effective cut-out air flue 100.Therefore, can effectively cut off nerve signal and can not form the damage of extending, and this can further reduce narrow formation along whole airway walls.

During RF melted, heat can be concentrated in one or more internal layers (for example, substrate) of airway walls or concentrate in the inner membrance (for example, epithelium) of airway walls.And the one or more blood vessels in the arteriae bronchiales branch can be positioned at damage.Can control the heat that uses electrode 214 to be produced, make that the ramose blood of the arteriae bronchiales of flowing through can protect these branches to avoid the hot injury, even said nervous tissue is positioned near the said arterial branch when the nerve trunk tissue is damaged.Conduit 207 can produce relative cell death than the zonule.For example, can destroy in the middle of the airway walls 100 or along the tissue of 2mm to the 3mm section of the outer surface of airway walls 100.Through using suitable power and suitable cooling, can produce damage in any desired degree of depth.

The resistance of air flue cartilaginous ring or cartilage layers is usually significantly greater than the resistance of air flue soft tissue (for example, smooth muscle or connective tissue).The air flue cartilage hinders energy stream (for example, electric radio-frequency current), and makes when electrode during near cartilage, forms therapeutic by radio-frequency electrical energy and damages and influence the air flue nerve trunk and become challenging.

Shown energy emitter 214 can be used as energy emitter between cartilage.The size of electrode member 227 can be set to the interval that meets cartilaginous ring 235a, 235b (being referred to as " 235 ") substantially.Shown in figure 13, each electrode member 227 is placed between two adjacent ring 235a, the 235b, makes damage 237 place fully in the space 333 of 235 of cartilaginous rings.

Electrode 229 can be used as localizer between cartilage, and its preferential help is seated in electrode member 227 in the space 333, and then makes and be easy to handle or be easy to examine correct positioning.For example, electrode member 227 can outwards be given prominence to and be easy to move into and coupling is more softish, in the better space 333 of compliance.Thereby electrode 229 can be used for indicating ablation member 208.

Figure 15 has shown electrode, and this electrode is the monopolar electrode that connects through a power line.Can simultaneously electric power be delivered to said electrode.Can place any amount of electrode along capsule 212.For example, can be along the circumference of said capsule one or more electrodes at interval equably or unevenly.

Figure 16 has shown that direction has the electrode 310a-310c (being referred to as " 310 ") at oblique angle with respect to the longitudinal axis 312 of ablation member 300.Power line 316a-316c (being referred to as " 316 ") is to dividing other electrode 310 that energy is provided.(although do not show, can other electrode be placed on the invisible rear side of ablation member 300).Electrode 310 can be a bipolar electrode.For instance, electrode 310a can comprise electrode member 318a, 319a, and electrode member 318a, 319a can positive and negative (or negative electrode and anodes), so as between element 318a, 319a transmission RF energy.

Can based on circle spacing of expecting between the length, adjacent damage of the damage that will form wait the angle [alpha] of selecting between electrode 310 and the longitudinal axis 312 directions.Shown angle [alpha] is about 45 degree.If desired or hope, also possibly be other angle.Can exist between the adjacent electrode 310 be untreated, unmarred tissue regions.

Shown in figure 16; Place damage by electrode or electrode pair 310a produce is overlapping with the start-up portion of next the place's damage that is produced by electrode adjacent on the circumference or electrode pair 310b in a circumferential direction, thereby guarantees to handle the whole circumference (or its part) of tubular body structure.If an end of the damage that is produced through electrode 310a is vertically drawn a virtual line, near the end of this virtual adjacent damage that line and 310b produced is crossing or approaching so.Therefore, the end of adjacent damage axially departs from and overlapping in a circumferential direction along axle 312.

Figure 17 has shown ablation member 400, and it comprises extensible basket 414 and electrode 413,415.Basket 414 comprises hollow member, and the coolant said hollow member of can flowing through is come cooling electrode 413,415.Can select the longitudinal length of basket 414, make basket 414 extend across a plurality of cartilaginous rings.Electrode 413,415 can be placed between the said ring.For example, microscler basket 414 can extend across at least three cartilaginous rings (by vertical dotted line 431,432,433 expressions of Figure 17).Electrode 413 is placed on cartilaginous ring 431, between 432.Electrode 415 is placed on cartilaginous ring 432, between 433.When basket 414 launched, the distance B that the electrode of adjacent rows is 413,415 was equivalent to the distance between cartilaginous ring substantially, and then guarantees that electrode 413,415 can be seated between cartilaginous ring.Electrode 413a can have first polarity, and electrode 413b can have antipole property, makes energy between said electrode, to flow.Electrode pair 413a, 413b and adjacent electrode depart from certain angle to 415a, 415b, thereby form on the circumferencial direction overlapping and in axially spaced damage.Overlapping D can handle the whole circumference of air flue apart from sufficient to guarantee.

Figure 18 has shown that along the chamber 427,429 flow and the fluid through decompression member 423,425 respectively.Term used herein " decompression member " is meant, and is not limited to, and is configured to reduce the device of the pressure of working fluid.Decompression member can be reduced to the pressure of working fluid the pressure for vaporization that is equal to or less than working fluid.Working fluid can comprise cold-producing medium (for example, low-temperature refrigerant or non-low-temperature refrigerant).In some embodiments, the form of decompression member is air relief valve or expansion valve, and they can make at least a portion vaporization of the working fluid that therefrom flows through.The working fluid (for example, cold-producing medium, cryogen etc.) of decompression member vaporization effective dose is to reduce the temperature of working fluid.In some patterns, the almost whole or most of working fluid through element 423,425 is converted into low temperature, low-pressure gas by weight.In some embodiments, decompression member 423,425 can be the valve that nozzle group valve, needle valve, Joule-Thomson valve, throttle element or any pressure that other is suitable for providing required descend.For example, Joule-Thomson valve can cause lower downstream temperature from the reclaiming by swelling work capacity of liquid.In some embodiments, can enough Flow-rate adjustment elements (for example, valve system) substitute decompression member, be under the situation such as the non-cold-producing medium of water especially at working fluid.

With reference to Figure 18, the gases at high pressure P of Figure 18 ₁Through delivery lumen 427,429.Gases at high pressure P ₁Through element 423,425, and admission passage 436,438, pressure drops to P in passage 436,438 ₂Pressure is from P ₁Drop to P ₂Cause gas temperature from T ₁Drop to T ₂The amplitude of variations in temperature is by computes:

T ₁-T ₂＝μ(P ₁-P ₂)

Wherein

T is the temperature of gas;

P is the pressure of gas;

μ is the Joule-Thomson coefficient of gas;

Subscript 1 expression condition of high voltage; And

Subscript 2 expression low pressure conditions.

As combine Figure 19 and 20 to be discussed, when the gas in the passage 436,438 is discharged through outlet and dropped to ambient pressure, second pressure takes place descend.If ablation member 400 is used for respiratory system, then ambient pressure is an atmospheric pressure.This temperature drops to:

T ₂-T ₃＝μ(P ₂-P _ATM)

Joule-Thomson coefficient (μ) is special for every kind of gas or admixture of gas.The standard temperature value of μ is:

Carbon dioxide

${\mathrm{\μ}}_{{\mathrm{CO}}_2}=1.16\×{10}^{-5}\frac{K}{\mathrm{Pa}}$

Air

These coefficients show, descend CO for given pressure ₂The temperature suppression ratio that causes descends big 5 times by the similar pressure that air produces.

It is desirable in lung, using air.Can use carbon dioxide, but condition to be the flow velocity of coolant gas enough low and be no more than individuality this extra carbon dioxide is discharged the outer ability of lung.If the coolant in the ooling channel is the highly pressurised liquid such as liquid air or liquid carbon dioxide, then cooling effect can be enhanced.Also experience is from the heat absorption phase transformation of highly pressurised liquid to gases at high pressure through decompression member (for example, choke valve) for highly pressurised liquid, and this makes the temperature of gas be lower than the temperature of highly pressurised liquid.Then, discussed as combining Figure 19 and 20, before discharging through outlet 441, this gas is through the P that associates ₁To P ₂Joule-Thomson expansion, temperature is further descended.

Figure 19 and 20 has shown the ablation member 437 similar substantially with 18 ablation member 400 with Figure 17, but following details difference to some extent.Ablation member 437 comprises along the opening of long element setting or exports 439 array.The coolant of long element of flowing through can spill to cool off contiguous tissue from opening 439.In addition, be arranged on the opening of far-end 443 or export 441 and can discharge coolant.Shown in figure 20, the coolant of representing with arrow can spill from exporting 439,441.By this way, coolant can cool off ablation member 437 and direct tissue cooling can be provided.Randomly, the pressure that outlet 441 can be configured to provide suitable descends, thereby makes coolant Joule-Thomson expansion vaporization by mentioned earlier, reduces coolant temperature thus.

Figure 21 has shown ablation member 450, and it has along deployable member 453 at the isolated V-arrangement electrode of circumferencial direction.Electrode 455 has end 456,457, and the tip 459 of end 456,457 and adjacent electrode 455 is overlapping.Electrode can be to V-arrangement target area output energy, and said V-arrangement target area is opened and formed the V-arrangement damage along the air flue circle spacing equally.Untreated tissue between V-arrangement damage can assist in ensuring that the air flue chamber can be owing to scar tissue or narrow and significantly narrow down.

Figure 22 has shown ablation member 460, and it comprises the extensible element 462 that carries T shape electrode.Electrode 463 has free terminal 464, and free terminal 464 is overlapping with the end 465 of adjacent electrode 467.The electrode 461 of alignment can form the damage that many places are substantially T shape in a circumferential direction.In other embodiments, electrode can be U-shaped, S shape, W shape, L shaped or any other suitable shape.In addition, in any one of these embodiments, electrode can with electrode shown in Figure 16 similarly with the pattern vertical misalignment of oblique or spiral.

Figure 23 has shown ablation member 500, and it comprises and can electrode 512 be placed on first group leader's shape member 511a-511d (being referred to as " 511 ") between the cartilaginous ring 513,515 (showing with dotted line).Long element 521a-521d (being referred to as " 521 ") carries and is placed on cartilaginous ring 515, the electrode 523a between 518,523b, 523c, 523d (being referred to as " 523 ").Electrode 512 forms damage at ring 513, between 515.Electrode 523 forms damage at ring 515, between 518.Long element 511,521 can be flexible or elastic bar or line; They are radially outward setovered; Make electrode against airway walls; And they are configured to use each electrode pair can handle the different circumferential area of airway walls with being placed on the position of departing from a circumferential direction with respect to electrode 512 by electrode 523, making.One end of the damage between collagen in the gap in a circumferential direction can and adjacent collagen between the adjacent damage in gap overlapping.Thereby damage separates each other on can be axially, but overlapping with respect to body cavity in a circumferential direction.Long element 511,521 can be contracted in the tubular sheath 510, makes long element 511,521 collapse to the radial contraction configuration that is suitable for importing in the air flue.

Figure 24 has shown the ablation member 600 with extensible energy emitter assembly 610.Extensible electrode assemblie 623 can surround the whole or most of of extensible member 620, and extensible member 620 is shown as capsule.Insulator 625 extends between the end on the part of electrode assemblie 623.Electrode 623 can have zigzag configuration (demonstration), curl shape structure or waveform structure, thereby can allow expansion and can around capsule 620, extend about 90 degree to about 360 degree.During use, exposed electrodes 623 can be regional towards pending air flue, for example, and the rear side that nerve trunk is usually located at.Perhaps, emitter assemblies 610 can comprise a plurality of exposed electrodes, and said electrode is separated by insulated part, thereby produces dispersive damage.

Randomly, second energy emitter 618 is placed on the distally of energy emitter 610.Energy emitter 618 has exposed electrodes 621 and insulator 623.Electrode 621 can cooperate with electrode 623 and form and depart from a circumferential direction and damage at axially spaced-apart complementary (for example, eclipsed).For example, electrode 623 can form the damage that arc length is about 180 degree along the top of airway walls.Electrode 621 can form the damage that arc length is about 180 degree along the bottom of airway walls.The damage of two places is extended along the whole circumference of airway walls jointly.Can produce or produce in succession damage simultaneously.

Figure 25 has shown ablation member 700, and it comprises the energy emitter of electrode assemblie 710 forms, and electrode assemblie 710 is wrapped in around the extensible element 712.Electrode assemblie 710 comprises pipeline 731 and a plurality of electrode 715a-h (being referred to as " 715 ").Electrode 715 can while or formation damage in succession.

With reference to Figure 26, electrode 715a can be the tubular metallic member of hollow, and when capsule 712 expanded, said electrode was directed with the cardinal principle circumferencial direction.Pipeline 731 is sent coolant (saline or other coolant) continuously through electrode 716.

Can different coolants be sent through capsule 712 and pipeline 731.Can flow through delivery lumen 761, the pipeline 731 of flowing through of coolant come cooling electrode 715.Can flow through delivery lumen 751 and flow into capsule 712 of another coolant.Coolant in capsule 712 and the pipeline 731 can flow to nearside through return cavity 739.In other embodiments, the coolant Continuous Flow is through electrode assemblie 710 and capsule 712.

Can independent lead pair be electrically connected with each electrode 715.Can operate each electrode 715 independently.In other embodiments, electrode 715 is bipolar, and it is paired to be arranged to antipole property.As about before embodiment said, thereby electrode 715 is can be relative to each other directed and place and form the damage in the space between cartilage.With the U.S. Patent application of submitting on May 8th, 2009 the 12/463rd; The U.S. Patent application the 12/913rd that No. 304 and on October 27th, 2010 submit to; Incorporate this paper by reference in full into No. 702, above-mentioned patent application discloses can be with technology, material, conduit and the parts of ablation member 700 uses.

Electrode 715a-h arranges along spirality pipe 731, makes them to produce in a circumferential direction to depart from each other (although have some overlapping) and in the damage that axially departs from each other.To intersect with another dummy line among the electrode 715a-h with the dummy line of axial direction (parallel) through each drafting among the electrode 715a-h, thereby guarantee to handle the whole circumference of air flue with axle 719.Advantageously, electrode is spaced apart along spirality pipe 731, makes the damage that they produced vertically separate along air flue, thereby reduces to cause narrow chance.

Temperature through regulating coolant, coolant flow speed, the heat-carrying capacity of coolant, the thermodynamic behaviour (for example, the heat transfer performance of capsule) or the amount of delivered power of capsule can be controlled the damage shape.Figure 27 A-31B shows through formed temperature spectrogram of the cooling that progressively improves capsule and corresponding damage.Can be through reducing coolant temperature or improving coolant flow speed or both improve the cooling capacity of capsule.Change the coolant capacity of electrode simultaneously or, also can realize setting through the cooling capacity substantially constant that keeps capsule damage through improving or reducing the power that is delivered to tissue.For instance, the ablation member 700 of Figure 25 can be used in the damage that forms Figure 27 B, 27C, 28B, 29B, 30B and 31B.Because the diameter of capsule 712 is greater than the diameter of electrode channel 753, so than the high velocity stream through electrode 715a, relatively low along the flow velocity on capsule surface.Produced the difference cooling like this.Flow if electrode 715a and capsule 712 have independently, then coolant can be in different temperature and/or flow velocity to be used for the difference cooling.

80 ° of C of isothermal line in Figure 27 A display organization, 60 ° of C and 40 ° of C and Temperature Distribution.Figure 27 B shows the isothermal damage 804 corresponding to Figure 27 A.The only coolant that can absorb a large amount of heats of coolant in the cooling duct 753.Capsule 712 does not absorb great amount of heat energy and can be filled with temperature and equals room temperature or the fluid in the scope of about 20 ° of C-30 ° of C substantially.In some embodiments, utilize surrounding air to come swelling bag 712, and capsule 712 can keep electrode 715a against tissue 825.In other embodiments, utilize warm saline to come swelling bag 712.Damage 804 has and is substantially semicircular shape.Can increase or reduce radius r and depth D through the temperature that reduces or improve coolant in the cooling duct 753 respectively.In addition or alternatively, can increase or reduce radius r and depth D through the flow velocity that reduces or improve coolant respectively.

Can cold coolant be sent through capsule 712 to reduce the cross-sectional width of the damage on the tissue surface 825.Figure 28 A and Figure 28 B show when coolant cools electrode 715a and when cryogenic coolant with low-speed flow the isothermal line during through capsule 712 and be substantially oval-shaped damage 804 accordingly.Coolant in the capsule 712 absorbs the heat energy of capacity, thereby protection contacts with capsule-organizational interface or contiguous tissue.(comprise the embodiment shown in Figure 28 B) in some embodiments, damage 804 cross-sectional widths on the surface 825 are less than the cross-sectional width of the damage 804 on surface 825 among Figure 27 B.The cross-sectional width of the damage 804 of Figure 28 B increases to Breadth Maximum W with the degree of depth _Maximum, and drop to the darkest zone 830 subsequently.Breadth Maximum W _MaximumDepth D less than damage 804.The width of the damage 804 on Figure 28 B display surface 825 is not more than about 150% of electrode width.

Figure 29 A and Figure 29 B show when cryogenic coolant with high velocity stream through the coolant of capsule 712 or extremely low temperature with low-speed flow the isothermal line during through capsule 712 with damage 804.Similar lachrymal damage 804 is extended from tissue surface 825.The shallow-layer of damage 804 or the width of narrow zone 834 approximate the cross-sectional width W of electrode 715a _ETherefore, the maximum cross-section width that has of the damage 804 of surface on 825 is not more than about 150% of electrode tissue interface.This has guaranteed to destroy the surface texture of minimum.Damage 804 outwards narrows down from shallow-layer part 834 to the zone 835 that enlarges gradually.The damage cross section width increases to Breadth Maximum W gradually with the degree of depth _MaximumBreadth Maximum W _MaximumCan be than the cross-sectional width about 1 on surface 825 to about 5 times.The darkest zone 830 of damage 804 is a part circular.

Figure 30 A and 30B show that the coolant when extremely low temperature damages 804 with isothermal line and tear drop shape that high velocity stream can form through through capsule 712 time.Damage 804 is from tissue surface 825 extensions and have narrow shallow-layer zone 834, and this shallow-layer zone 834 outwards extends to wide by dark regional 852 fast.The width in shallow-layer zone 834 is less than the width W of electrode 715a _ECross-sectional width is rapidly increased to Breadth Maximum W with the degree of depth _MaximumTherefore, most of volume of damage 804 is positioned at and organizes the depths.

Figure 31 A and Figure 31 B show that isothermal line that coolant when extremely low temperature can form during through capsule 712 with high velocity flow circularly damages 804 with corresponding.Damage 804 is positioned at from the depth D of tissue surface 825.The maximum cross-section width W of damage 804 _MaximumIn depth D _{Breadth Maximum}The place.Damage 804 and electrode tissue interface be separate and can have different shapes according to the flow velocity and the temperature of coolant.The difference cooling can be used in and obtains other damage shape of imbedding, such as being substantially ellipse, elongated shape etc.

Can select D according to the position of target area _{Breadth Maximum}In order to destroy nervous tissue, D _{Maximum Width}Can be at least about 2mm to guarantee damage and comprise nervous tissue and to alleviate or avoid smooth muscle tissue is caused obvious impairment.These embodiments are highly suitable for handling airway walls, because the degree of depth of smooth muscle tissue is not less than 2mm usually.By this way, the cross-sectional width of target area can reach maximum in the degree of depth darker than smooth muscle tissue.Most (and whole basically in some embodiments) damage is arranged in the tissue of non-flat muscular tissue, and its position in airway walls is darker than smooth muscle tissue zone usually.In addition, can be to any destruction of the smooth muscle cell in the airway walls less than under the situation of not destroying nervous tissue, changing the reactive of air flue in fact or shrinking (such as because asthma, COPD or other pneumonopathy) required destructive amount.

Damage can separate through protection zone and tissue surface, a large amount of organizing not by permanent damage in the protection zone.Figure 31 B and Figure 32 B display depth are D _PProtection zone 861.Advantageously, because organizing in a large number not by permanent damage in the protection zone 861, its function of organization can be retained.The D of the degree of depth _PCan be at least about 1mm to about 2mm to melt nervous tissue.

Figure 32 has shown spiral type ablation member 900, and it comprises crooked (being shown as spiral type) main body 910 (be shown as be tapered with the coupling air flue gradually thin) and electrode 912a, 912b, 912c (being referred to as " 912 ").Randomly, can one or more decompression members be placed in the main body 910 and serve as Joule-Thomson valve, thus the temperature of reduction coolant.

Therefore electrode 912 can be similar each other substantially, and be applicable to other electrode for the description of an electrode with also being equal to, only if point out in addition.Electrode 912a comprises a plurality of outlets 916,918.The coolant of being represented by arrow can flow out outlet 916,918.Electrode 912a can be connected with the outer surface of main body 910.This allows electrode 912 outwards outstanding enough distances, thereby can contact with organizing physics.The arrangement of electrode 912 can produce such damage; Said damage departs from a circumferential direction each other; But have the overlapping of some circumferencial direction at its edge, the dummy line of promptly vertically drawing through the end of place damage downwards along air flue will intersect with the end of next place's damage.Because electrode 912 is spaced apart along spirillum 910, thus the damage that they produced air flue axially on also spaced apart, and then reduce narrow probability.

Main body 910 can comprise material (like Nitinol (Nitinol)) pliable and tough and conduction, and when starting, these materials can form spiral type or corkscrew shape.Can warm fluid be sent through main body 910, cause main body 910 to move to expansion configuration (for example, configuration of corkscrew shape or helical configuration) from sending configuration (configuration of for example, stretching).In other embodiments, main body 910 can be offset to launches configuration, and can be sent out sleeve pipe or working chamber launches configuration to appear.Thereby can ablation member 900 proximads be drawn in sleeve pipe or working chamber returns ablation member 900 to send configuration.In other embodiments, can use stretcher, draught line, draw bar etc. to make main body 910 present different configurations.

Randomly, can place capsule through interior zone 920.Can the capsule of the capsule that is substantially conical capsule, columniform capsule, hot dog shape or other suitable shape be inserted interior zone 920.

Figure 33 has shown the spiral type ablation member of being processed by tubulose conductivity internals 952; Said ablation member 952 has the exposure section that array of spaced forms electrode 960a, 960b, 960c (being referred to as " 960 "), and on spacer segment, has the insulation covering to form insulating regions 962a, 962b, 962c.Coolant can be through ablation member 520 circulations with cooling electrode 960.For extra tissue cooling is provided, randomly, the outlet (not shown) during coolant can cover through inner tubular member and/or insulating properties is sent away.

Figure 34 has shown the ablation member 1000 that comprises isolated bipolar electrode 1010a-f (being referred to as " 1010 ") array.Electrode arrangement is that opposite polarity is right, make each bipolar between obliquely produce damage.Electrode 1010 can form the oblique damage of crossing over cartilaginous ring.Shown in figure 35, ablation member 1000 is placed in the air flue 1012.Electrode 1010 is placed between the said ring.Electrode 1010a-c can produce the damage 1030 of Figure 36.One end 1032 of damage 1030 is near ring 1034.The other end 1036 adjacent loops 1038.Terminal 1032,1036 along axially skew each other of air flue 1012.Shown in figure 36, terminal 1032,1036 axial dipole field is significantly greater than terminal 1032,1036 circumferential distance.In some scheme, terminal 1032,1036 distance is at least 1 millimeter, 5 millimeters, 10 millimeters.In some embodiments, terminal 1032,1036 axial distance is greater than the distance between adjacent cartilaginous ring.This guaranteed the damage can cross over said ring.

The centre portion of the damage 1030 of Figure 36 is crossed over ring 1034, the ring between 1,038 1040. Electrode 1010d, 1010e, 1010f at ablation member 1000 dorsal parts form damage 1041.Shown damage 1041,1030 is positioned at offside and is in the different axial positions along air flue.

Electrode 1010 can protruding enough distances, thereby can interact with airway tissue, carry out electrode 1010 is remained between the cartilaginous ring.When operating with double pole mode, damage forms and crosses over said ring.After forming damage, can proximad retract conduit or distad promote conduit and be used to form the damage that axially departs from.In addition or alternatively, can steering nozzle, form oblique damage in position along the different angles of air flue 1012.The damage of Figure 36 is shown as successive damage.In other embodiments, damage can comprise the dispersive isolated damage in many places.For example, damage 1030 can comprise the array of isolated damage.

Figure 37 and 38 shown depart from a circumferential direction and spaced apart in the axial direction, can carry out refrigerative electrode 1050a, 1050b through internal spray.Coolant flow 1054 leaves through delivery lumen 1052 and after opening.The coolant that sprays flows with cooling electrode 1050a along the cooling duct 1056 of opening.Coolant leaves chamber 1060 through outlet 1062a, 1062b.Coolant flows along return cavity 1072.When cooling, can operate electrode 1050a, 1050b with monopolar mode or double pole mode.

Figure 39 A-40B has shown ablation member 1080, and it comprises the energy emitter of electrode assemblie 1082 forms.Electrode assemblie 1082 comprises electrode 1084a-f (being referred to as " the 1084 ") array that can form damage 1083 (Figure 39 B and 40B).Can form a large amount of dissimilar curl shape, curved, zigzag, Z-shaped or structure that other are different.Shown damage 1083 is substantially spiral type and crosses over a plurality of cartilaginous rings.Ablation member 1080 can have any amount of this type electrode assemblie 1082.For example, can a pair of spiral type ablation member 1082 be placed on the outside of ablation member 1080.

Shown damage 1083 is successive, and has the end of opening along major axis 1089 axially spaced-aparts of air flue 1085,1087. Terminal 1085,1087 also angled each other departing from.Shown in Figure 39 B and 40B, terminal 1085, between 1087 along the distance of axle 1089 greater than the distance between the adjacent ring.Like this, a plurality of rings are crossed in damage 1083.

Electrode 1084 can be closer to each other and the successive basically damage 1083 of formation.The distance that in other embodiments, can increase by 1084 at electrode is to provide many places isolated damage.Isolated damage can be arranged in and damage 1083 shapes similar, but also possibly be other shape and pattern of lesions.

Figure 41 has shown ablation member 1100, and it has the electrode assemblie 1110 that is wrapped in around the capsule 1111.Electrode assemblie 1110 comprises the pipe 1113 that is suitable for holding coolant, and has the far-end 1115 with the internal communication of capsule 1111.Electrode is installed, is adhered to, sprays or otherwise is connected in the outside of pipe 1113.By this way, can coolant be delivered to the inside of capsule 1111 through conduit, with swelling bag 1111, coolant is from capsule 1111 flowing pipes 1113, and then cooling electrode.Perhaps, coolant can cooling electrode, and cooling bladder 1111 subsequently.Electrode assemblie 1110 can provide difference cooling, the damage that has certain shape with formation with capsule 1111.

Figure 42-44 has shown and can move to the ablation member 1200 of launching configuration (Figure 43 and 44) from sending configuration (Figure 42).In sending configuration, the distal part of ablation member 1,200 1211 is lined up line with the portions of proximal of catheter shaft 1213, so that the air flue that is inserted with ablation member 1200 or the longitudinal axis of other body cavity align substantially.In launching configuration, the distal part 1211 crooked or distortion of ablation member 1200, thus form ring 1215, the plane that ring 1215 is positioned at transverse to the longitudinal axis of catheter shaft 1213 near-ends.By this way, ring 1215 can extend in the periphery of inner wall of air flue, thereby electrode 1220 is placed spaced positions place on a series of circumferencial directions of air flue.

In launching configuration, said ring can be spiral or can be positioned at the plane that becomes oblique angle with the longitudinal axis of catheter shaft 1213, makes electrode 1220 be placed in the position that axially separates along airway walls.Can utilize various known means to launch to encircle 1215.For example, draught line can extend through the chamber of catheter shaft slidably, and is fixed near the point the far-end, makes tension force on the draught line will encircle 1215 and is launched into required configuration.Perhaps, the distal part of conduit can be disposed for launching by pre-setting, and can be resilient, makes distal part between delivery period, can be compressed in the sheath, then, is released through the said sheath of withdrawing, and makes distal part recover to launch configuration.

Outlet 1210a-1210c (being referred to as " 1210 ") provides direct coolant cools for tissue.But independent operation electrode 1220a-c (being referred to as " 1120 ") is to form dispersive damage, and perhaps co-operate is formed for forming a total electrode of continuous damage.Can electrode 1220 be placed between bronchial two cartilaginous rings of nearside trunk, to handle about 1/3rd (for example, the front middle part zone of air flue or front and rear part zones) of air flue circumference.Then electrode 1220 is distad placed other 1/3rd front and rear part or the front middle part of handling airway walls between two distally cartilaginous rings again.Traveling electrode 120 is handled the rear portion 1/3rd of air flue, for example membrane portions once more.Coolant can be sent with cools tissue through exporting 1210.Ablation member 1200 can be used for the different sections of ablation vessels one after the other, and can distad move with proximad, between damage, enough intervals is provided, thereby alleviates scar tissue or narrow (if any).

Delivery apparatus disclosed herein can be handled digestive system, nervous system, vascular system or other system.For example, can handle vascular system through vascular delivery elongate member disclosed herein, tube chamber inner catheter and delivery apparatus.Processing system disclosed herein and parts thereof can be as the attached means of other medical care precess; Said other therapy is such as Wicresoft's operation, open-sky technique, semi open model operation or other operation technique (for example, lung volume dwindles operation) that arrives required target spot can be provided.Various thoracic surgeries can provide the entering lung tissue.Be used to provide the entering technology and the method that arrive the target area to carry out by doctor and/or robot system.Those skilled in the art understand the multiple diverse ways that can arrive the target area.

Lead, delivery sheath, optical instrument, introducer, sleeve pipe, biopsy needle or other suitable medical apparatus can be used to guide said delivery device.If the target processing site is in patient's distal position (for example, near the treatment site the radix pulmonis 24 of Fig. 1), then a lot of instruments and technology can be used in and arrive the site.For example, use such as the exercisable delivery apparatus of aforesaid endoscope and tracheascope and can be at an easy rate the elongate member of flexibility be positioned in the individual's body.

Semi-rigid or rigid elongate assembly can be sent in the following manner: use sleeve pipe, access port, use semi open model operable rigid delivery sheath, open-sky technique that more straight other means of delivery/method of sending passage maybe can be provided.Advantageously, the rigidity of semi-rigid or rigid elongate assembly can be enough strong, thereby arrive and handle tissue at a distance, such as vagus nerve, nervous ramification, nerve fiber and/or along the nerve trunk of air flue, and do not send elongate member through air flue.Embodiment disclosed herein and technology can be used with other operation, such as bronchus hot forming art.

Only if context has requirement in addition; Whole description and claim are all followed: word " comprises (comprise) " and alternative word; Such as " comprising (comprises) " and " comprising (comprising) "; All should be interpreted as implication open, that comprise, promptly be interpreted as " including but not limited to ".

Can be with above-mentioned different embodiments combination so that other embodiment to be provided.Under the instruction of the detailed description of preceding text, can carry out these to embodiment and change and other change.Embodiment disclosed herein, characteristic, system, device, material, method and technology in some embodiments with the described embodiment of following document, characteristic, system, device, material, method and technology in any one or a plurality of similar: the application the 12/463rd that on May 8th, 2009 submitted to; The U. S. application the 12/913rd that on October 27th, No. 304 1 submitted to; The U.S. Provisional Patent Application the 61/255th that on October 27th, No. 702 1 submitted to; No. the 61/260th, 348, the U.S. Provisional Patent Application of submitting in No. 367 and on November 11st, 2009.By reference each integral body in these applications is integrated with this paper.In addition; Embodiment described herein, characteristic, system, device, material, method and technology can be applied to above-mentioned U.S. Patent application series the 12/463rd in certain embodiments; Disclosed embodiment, characteristic, system, device, material, method and technology or use in No. the 12/913rd, 702, No. 304 and the U. S. application submitted on October 27th, 2010 with their combinations.For example, disclosed device can merge electrode disclosed herein or further feature in No. the 12/913rd, 702, No. the 12/463rd, 304, U.S. Patent application series and the U. S. application submitted on October 27th, 2010.

In addition; Embodiment described herein, characteristic, system, delivery apparatus, material, method and technology can be applied to the application the 12/463rd of submission on May 8th, 1 in certain embodiments; The U. S. application the 12/913rd that on October 27th, No. 304 1 submitted to; 702, the U.S. Provisional Patent Application of submitting on October 27th, 2009 the 61/255th; Any or multiple in U.S. Provisional Patent Application the 61/260th, No. 348 disclosed embodiment, characteristic, system, device, material, method and technology of submitting in No. 367 and on November 11st, 2009 or be used in combination with them.

Usually; In following claims; Used term should not be interpreted as claim is limited to description and the disclosed specific embodiments of claims, and should be interpreted as all possible embodiment of the equivalent way of the four corner that comprises that claim is represented.Therefore, claims do not receive the restriction of disclosure.

Can other embodiment be provided with each embodiment combination mentioned above.The whole United States Patent (USP)s, the U.S. Patent application that go out with the application materials tabular that this description is quoted is open, U.S. Patent application, foreign patent, foreign patent application and non-patent publications are incorporated this paper by reference in full into.If necessary can utilize the design of different patents, application and publication to change the various aspects of said embodiment, thereby other embodiment is provided.

Under the instruction of the similar description of preceding text, can carry out these to said embodiment and change and other change.Usually; In following claims; Term should not be interpreted as claims are limited to this description and the disclosed concrete embodiment of claims, and should be interpreted as all possible embodiment of the four corner of the equivalents that comprises that these claim is enjoyed.Therefore, claims should not receive the restriction of disclosure.

Claims (51)

1. energy delivery apparatus, it comprises catheter shaft and ablation member,

Said ablation member links to each other with said catheter shaft, and comprises energy emitter between cooling element and cartilage,

Said cooling element can move from collapsed mode and be deployed condition,

Energy emitter comprises a plurality of electrodes that the longitudinal axis around said ablation member squints at circumferencial direction each other between said cartilage; Said electrode is configured to can be to a plurality of target areas of air flue delivery of energy; Said a plurality of target area is spaced apart from each other with respect to the longitudinal axis of said ablation member; And wherein said energy emitter and said cooling element are configured to cooperatively interact and form and damage between cartilage, and the surface texture of damage and said air flue separates and between the cartilaginous ring of said air flue between said cartilage.

2. energy delivery apparatus as claimed in claim 1, wherein said energy emitter are configured to produce the damage that is spaced apart from each other along the major axis of said air flue.

3. energy delivery apparatus as claimed in claim 1, wherein said target area along the long axis direction of said air flue with the orthogonal virtual plane of the major axis of said air flue on projection limit basic closed ring.

4. energy delivery apparatus as claimed in claim 1, at least a portion of wherein said ablation member are spirally or spiral type.

5. energy delivery apparatus as claimed in claim 1, wherein when when the chamber of said air flue is observed downwards, at least a portion of two target areas is eclipsed.

6. energy delivery apparatus as claimed in claim 1, wherein said catheter shaft have and are used for the delivery lumen of sending coolant to said cooling element and said energy emitter.

7. energy delivery apparatus as claimed in claim 1; The cooling duct of wherein said energy emitter is what to separate with the chamber of said cooling element; Thereby allow the passage of first coolant, and allow chamber the second coolant independent delivery to said cooling element from said catheter shaft independent delivery to said energy emitter.

8. energy delivery apparatus as claimed in claim 1, wherein said energy emitter comprises the electrode with coolant channel, said coolant channel is used to make coolant from wherein flowing through.

9. energy delivery apparatus as claimed in claim 1, wherein said cooling element comprises extensible basket, and said extensible basket has the hollow elongated member, and said hollow elongated member has coolant channel.

10. energy delivery apparatus as claimed in claim 1; Wherein at least one electrode is configured to when said cooling element is in deployed condition, to export the part that enough RF energies melt the nerve trunk of extending along bronchial tree; Thereby weaken the nervous system signal of a part that transfers to said bronchial tree; And wherein said cooling element absorbs enough heat energy from the wall of said air flue, thereby can limit or prevent the tissue between said energy emitter and the said nervous tissue is damaged.

11. delivery apparatus in the tube chamber, it comprises:

Ablation member; Said ablation member comprises extensible device and a plurality of electrode; The circle spacing of the said extensible member in said electrode edge opens and can be to dispersive target area output energy; Thereby it is form damage in said target area, and at least a portion of wherein first damage is spaced apart with second damage in the axial direction, and contiguous or overlapping with second damage in a circumferential direction.

12. delivery apparatus in the tube chamber as claimed in claim 11, wherein said electrode is configured to form one group of damage, and said one group of damage axially separates with the longitudinal axis of second group of damage along said ablation member.

13. delivery apparatus in the tube chamber as claimed in claim 11, wherein said electrode is V-arrangement or T shape.

14. delivery apparatus in the tube chamber as claimed in claim 11, wherein said extensible device comprises a plurality of teeth, and said tooth has the free terminal that carries said electrode.

15. delivery apparatus in the tube chamber as claimed in claim 11, wherein at least one electrode has the cooling duct, and fluid can flow through said cooling duct and cool off said electrode, and wherein said extensible device comprises capsule or extensible basket.

16. delivery apparatus in the tube chamber as claimed in claim 11; Wherein said extensible device can be that spiral launches configuration from sending configuration mobile; And when said extensible device was in the expansion configuration, said electrode is placed in can be to the position of target area delivery of energy.

17. delivery apparatus in the tube chamber as claimed in claim 11, wherein said electrode can be by such placements: make the target area along the y direction of said ablation member with the orthogonal virtual plane of the said longitudinal axis on projection limit basic closed ring.

18. delivery apparatus in the tube chamber as claimed in claim 11, wherein said electrode can be by such placements: make the target area along the y direction of said ablation member with the orthogonal virtual plane of the said longitudinal axis on projection limit arc processing region.

19. delivery apparatus in the tube chamber as claimed in claim 11, wherein said electrode are configured to can be to the contiguous target area output energy in two places, makes that the eclipsed distance of circumference is at least 0.5mm between the contiguous target area, said two places.

20. the method that treatment is individual, it comprises:

Place ablation member with respect to air flue; And

To target area that the axially spaced-apart of said air flue is opened output energy, and wherein when along the long axis direction observation of said air flue, the profile of said target area is overlapping from said ablation member.

21. method as claimed in claim 20; First place that also is included in said target area forms first damage; And in second place of said target area formation, second damage; And wherein when when the long axis direction of said air flue is observed, it is a part of overlapping that the part of said first damage and said second is damaged.

22. method as claimed in claim 20, wherein said ablation member are configured to and can form damage in said target area, the chamber of said air flue is surrounded in the damage of every place at least in part.

23. method as claimed in claim 20; Comprise that also heating is in the degree of depth in the said airway walls and causes cell death greater than the tissue at about 2mm place, will be in the degree of depth in the said airway walls simultaneously and maintain the temperature that is lower than the cell death occurrence temperature less than the tissue at 2mm place.

24. method as claimed in claim 20 also comprises coolant sent through said ablation member and comes in the cooling airway degree of depth less than the tissue at 2mm place.

25. the method that treatment is individual, it comprises:

Move the energy emitter of delivery apparatus along air flue;

At least one electrode of said energy emitter is placed between the cartilaginous ring of said air flue; And

From the target area delivery of energy of said electrode, damage to form between cartilaginous ring to the position that axially separates along said air flue major axis.

26., comprise that also the wall that cools off said air flue is to protect the interior tissue of said air flue like the said method of claim 25.

27., also comprise at least two places damage that formation overlaps each other in a circumferential direction like the said method of claim 25.

28. like the said method of claim 25; One of wherein said damage is positioned at and orthogonal first virtual plane of the major axis of said air flue; And another place's damage is positioned at and orthogonal second virtual plane of the major axis of said air flue, and wherein said first virtual plane and said second virtual plane are along the major axis axially-spaced of said air flue.

29. like the said method of claim 25, when also being included in delivery of energy, cool off the wall of said air flue, thereby limit or prevent the cells of tissues death between nerve trunk and said energy emitter.

30. like the said method of claim 25; Comprise that also heating is in the degree of depth in the said airway walls and causes cell death at least about the tissue at 2mm place, will be in the degree of depth in the said airway walls simultaneously and maintain the temperature that is lower than the cell death occurrence temperature less than the tissue at 2mm place.

31. like the said method of claim 25, also comprise when said electrode is exported energy, coolant sent through said electrode.

32. handle the method for tissue, it comprises:

Ablation member is placed on the air flue intracavity; And

Utilize and be placed near the organize delivery of energy of at least one electrode of said air flue inner surface in the said ablation member to said air flue; Wherein said energy destroys the target area that axially separates along said air flue, and the target area part of the maximum cross-section width of the said target area of feasible qualification is separated with the inner surface of said air flue.

33., when also being included in delivery of energy a plurality of electrodes are placed between the cartilaginous ring like the said method of claim 32.

34., comprise that also delivery of energy is to form spiral type damage of at least one place or spirally damage like the said method of claim 32.

35. like the said method of claim 32, the maximum cross-section width of target area, wherein at least one place is positioned at apart from the air flue inner surface degree of depth place of 2mm at least of the said ablation member of contact.

36. like the said method of claim 32, also comprise the tissue that destroys target area, at least one place, make the darker degree of depth place, cross-sectional width smooth muscle tissue zone in of destructive tissue than said tissue reach maximum.

37. like the said method of claim 32, wherein delivery of energy comprises destruction target area, at least one place, makes the major part of this target area be positioned at outside the smooth muscle tissue zone of said tissue.

38. like the said method of claim 37, wherein most of volume of destructive tissue be positioned at outside the smooth muscle tissue zone.

39. delivery apparatus comprises

Catheter shaft; And

The ablation member that is connected with said catheter shaft; Said ablation member comprises and can move extensible element and energy emitter into deployed condition from sending state; When said extensible element is in deployed condition; Said energy emitter can produce damage by emitted energy, and said damage has the end that is axially offset to one another along the axial length of body structure.

40. delivery apparatus as claimed in claim 39, wherein said energy emitter comprises a plurality of electrodes, and said electrode is configured to form spirally damage, spiral type damage or Z-shaped damage.

41. delivery apparatus as claimed in claim 39, wherein said energy emitter are wrapped in said extensible component ambient.

42. delivery apparatus as claimed in claim 39; One end of wherein said energy emitter extends around said extensible element in a circumferential direction; The other end of said energy emitter extends around said extensible element in a circumferential direction, and the zone line of said energy emitter around said extensible element with respect to the oblique extension of the longitudinal axis of said ablation member.

43. delivery apparatus as claimed in claim 39, a plurality of electrodes of wherein said energy emitter along said ablation member with respect to the oblique extension of the longitudinal axis of said ablation member.

44. delivery apparatus as claimed in claim 39, wherein said energy emitter comprise a plurality of isolated electrodes, thereby can form spirally, spiral type or Z-shaped damage.

45. delivery apparatus as claimed in claim 44, wherein said damage are successive damage.

46. delivery apparatus as claimed in claim 45, wherein said damage are discontinuous damage.

47. the method that treatment is individual comprises:

Ablation member is positioned in the air flue, and

From said ablation member delivery of energy, thereby form the damage of at least one place, said damage has the opposite end that on the long axis direction of said air flue, axially departs from each other.

48. method as claimed in claim 47, wherein when the major axis of said ablation member is measured, said opposite end is at a distance of the distance of 5mm at least.

49. method as claimed in claim 47 comprises that also delivery of energy is to form spirally or spiral successive damage.

50. method as claimed in claim 47 also comprises forming spirally or spiral discontinuous damage.

51. method as claimed in claim 47, the damage of wherein at least one place comprises along a plurality of isolated damages of said air flue.

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